血栓栓塞风险评分与二尖瓣环钙化的相关性研究

Correlation between thromboembolic risk scoresand mitral annular calcification

目的:探讨影响二尖瓣环钙化(MAC)发生的危险因素及MAC与血栓栓塞风险评分(CHA2DS2-VASc和CHADS2评分)之间的相关性。方法:回顾性收集2020年1月至2022年12月在东南大学附属中大医院心血管内科住院患者的临床资料,根据患者超声心动图上二尖瓣环是否钙化分为MAC组109例和非MAC组110例。通过单因素及多因素分析评估影响MAC发生的危险因素,比较两组血栓栓塞风险评分差异以及血栓栓塞风险评分对MAC的预测价值。结果:Logistic回归分析显示,影响MAC的危险因素包括年龄、女性、高血压、心力衰竭、肾功能不全。MAC组比非MAC组CHADS2评分及CHA2DS2-VASc评分更高[分别为(2.93±1.2)分vs(1.86±1.25)分,(5.10±1.65)分vs(3.34±1.68)分,P<0.05]。ROC曲线分析显示,CHADS2评分预测MAC发生的曲线下面积为0.722(95%CI 0.665~0.789,P<0.05),CHA2DS2-VASc评分预测MAC发生的曲线下面积为0.773(95%CI 0.711~0.835,P<0.05)。结论:年龄、女性、高血压、心力衰竭、肾功能不全与MAC发生相关。MAC患者的CHA2DS2-VASc评分和CHADS2评分明显升高,提示将MAC与其他血管疾病指标一起纳入栓塞风险评估模型可能有助于早期识别高危栓塞患者并制定预防策略,从而改善患者的临床预后。

Objective:To investigate the risk factors of mitral annular calcification(MAC)and the correlation between MAC and thromboembolic risk scores(CHA2DS2-VASc and CHADS2 scores).Methods:The clinical data of patients hospitalized in the Department of Cardiology,Zhongda Hospital,Southeast University from January 2020 to December 2022 were retrospectively collected.According to whether the MAC was calcified on echocardiography,the patients were divided into two groups:the MAC group(n=109)and the non-MAC group(n=110).The risk factors affecting the occurrence of MAC were evaluated by univariate and multivariate analysis.The thromboembolic risk scores were calculated and compared between the groups and the predictive value of the thromboembolic risk scores to MAC.Results:Logistic regression analysis showed that the risk factors of MAC were age,female,hypertension,heart failure and chronic kidney disease.The scores of CHADS2 and CHA2DS2-VASc in patients with MAC were higher than those without MAC[(2.93±1.2)points vs(1.86±1.25)points,(5.10±1.65)points vs(3.34±1.68)points,P<0.005,respectively].ROC curve analyses showed that the areas under the curve(AUCs)of CHADS2 score for MAC and CHA2DS2-VASC score for MAC were 0.722(95%CI 0.665-0.789,P<0.05)and 0.773(95%CI 0.711-0.835,P<0.05),respectively.Conclusion:Age,female,hypertension,heart failure and chronic kidney disease were related to the occurrence of MAC.The CHA2DS2-VASc score and CHADS2 score in patients with MAC were significantly higher,suggesting that the inclusion of MAC in the embolization risk model together with other vascular disease indicators is expected to identify high-risk embolization patients early and formulate prevention strategies,thereby improving the clinical prognosis of patients.