基于心力衰竭超声指数及血清学指标构建急性失代偿性心力衰竭患者短期主要不良心血管事件发生风险的预测模型

Construction of a prediction model for the risk of short-term occurrence of major adverse cardiovascular events in patients with acute decompensated heart failure based on heart failure echocardiography index and serological indicato

目的基于心力衰竭超声指数(HFEI)及血清学指标构建急性失代偿性心力衰竭(ADHF)患者短期主要不良心血管事件(MACE)发生风险的预测模型。方法选取2018年6月至2021年6月海南医学院第一附属医院收治的ADHF患者190例,随访期间依据患者是否发生MACE分为MACE组80例和非MACE组110例。超声心动图检查测量左心室舒张末期内径(LVEDd)、左心室射血分数(LVEF)以及二尖瓣血流频谱E峰和A峰比值(E/A),并评估HFEI。采用COX回归分析影响ADHF患者短期MACE的危险因素。采用R软件构建预测ADHF患者短期MACE风险列线图模型。结果MACE组LVEDd、HFEI、尿酸、N末端脑钠肽前体(NT-proBNP)、尿素氮(BUN)水平明显高于非MACE组,差异有统计学意义(t=6.419、9.754、11.250、34.063、26.464,P<0.05),MACE组E/A、钠离子水平、LVEF明显低于非MACE组,差异有统计学意义(t=8.946、4.236、5.922,P<0.05)。COX回归分析结果显示,HFEI、尿酸、NT-proBNP是ADHF患者短期MACE的影响因素(HR=1.423、1.005、1.001,P<0.05)。预测ADHF患者短期MACE风险列线图模型的校准曲线,且Hosmer-Lemeshow拟合优度检验(χ2=7.381,P>0.05),一致性较好。ROC曲线下面积为0.879(95%CI=0.830~0.928),区分度较优。结论本研究构建的预测ADHF患者短期MACE风险列线图模型,具有较好的区分度和一致性。

Objective To construct a predictive model for the risk of short-term occurrence of major adverse cardiovascular events(MACE)in patients with acute decompensated heart failure(ADHF)based on the heart failure echocardiography index(HFEI)and serological indicator.Methods A total of 190 ADHF patients admitted to The First Affiliated Hospital of Hainan Medical University from June 2018 to June 2021 were selected.During the follow-up period,the patients were divided into the MACE group(80 cases)and the non-MACE group(110 cases)according to whether they experienced MACE.Echocardiography was performed to measure left ventricular end-diastolic diameter(LVEDd),left ventricular ejection fraction(LVEF),and the ratio of E-peak to A-peak of the mitral valve blood flow spectrum(E/A ratio),and the HFEI was assessed.Risk factors affecting short-term MACE in ADHF patients were analyzed by COX regression.R software was used to construct a nomogram model for predicting short-term MACE risk in ADHF patients.Results The levels of LVEDd,HFEI,uric acid,N-terminal pro-brain natriuretic peptide(NT-proBNP)and blood urea nitrogen(BUN)in the MACE group were significantly higher than those in the non-MACE group,with statistically significant difference(t=6.419,9.754,11.250,34.063,26.464;P<0.05).The E/A ratio,sodium ion level and LVEF in the MACE group were significantly lower than those in the non-MACE group(t=8.946,4.236,5.922;P<0.05).COX regression analysis showed that HFEI,uric acid and NT-proBNP were influencing factors for short-term MACE in ADHF patients(HR=1.423,1.005,1.001;P<0.05).The calibration curve of the nomogram model for predicting short-term MACE risk in ADHF patients showed good consistency,and the Hosmer-Lemeshow goodness-of-fit test indicated a good fit(χ2=7.381,P>0.05).The area under the ROC curve was 0.879(95%CI=0.830-0.928),showing good discrimination.Conclusion The nomogram model constructed in this study predicting short-term MACE risk in ADHF patients has good discrimination and consistency.