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基于心脏磁共振的诺莫图预测老年非梗阻肥厚型心肌病的预后研究

刘磊 李天娇 孙宾 任宏强

刘磊, 李天娇, 孙宾, 任宏强. 基于心脏磁共振的诺莫图预测老年非梗阻肥厚型心肌病的预后研究[J]. 中华全科医学, 2024, 22(2): 230-234. doi: 10.16766/j.cnki.issn.1674-4152.003372
引用本文: 刘磊, 李天娇, 孙宾, 任宏强. 基于心脏磁共振的诺莫图预测老年非梗阻肥厚型心肌病的预后研究[J]. 中华全科医学, 2024, 22(2): 230-234. doi: 10.16766/j.cnki.issn.1674-4152.003372
LIU Lei, LI Tianjiao, SUN Bin, REN Hongqiang. Prediction of prognosis in elderly nHCM patients using nomogram based on CMR and clinical characteristics[J]. Chinese Journal of General Practice, 2024, 22(2): 230-234. doi: 10.16766/j.cnki.issn.1674-4152.003372
Citation: LIU Lei, LI Tianjiao, SUN Bin, REN Hongqiang. Prediction of prognosis in elderly nHCM patients using nomogram based on CMR and clinical characteristics[J]. Chinese Journal of General Practice, 2024, 22(2): 230-234. doi: 10.16766/j.cnki.issn.1674-4152.003372

基于心脏磁共振的诺莫图预测老年非梗阻肥厚型心肌病的预后研究

doi: 10.16766/j.cnki.issn.1674-4152.003372
基金项目: 

四川省科技厅重点研发项目 2019YFS0345

详细信息
    通讯作者:

    任宏强,E-mail:rhq1980@163.com

  • 中图分类号: R542.2

Prediction of prognosis in elderly nHCM patients using nomogram based on CMR and clinical characteristics

  • 摘要:   目的  探讨老年非梗阻性肥厚型心肌病(nHCM)患者的生存预后,并建立一个基于心脏核磁共振(CMR)参数与临床特征的诺莫图来个体化评估nHCM患者的预后。  方法  回顾性分析2015年6月—2021年11月于遂宁市中心医院心血管中心与南充市中心医院心内科住院的179例nHCM患者,采用多因素Cox回归分析确定与患者OS相关的独立预后因素并绘制诺莫图,采用重采样法(Bootstrap)进行评估验证。  结果  多因素Cox回归分析显示影响预后的因素为半乳糖凝集素-3(Gal-3)、室性心动过速、心尖部室壁瘤、延迟强化(LGE)、运动负荷试验。基于以上因素绘制诺莫图,一致性指数(C-index)的Bootstrap校正值为0.908(95% CI:0.869~0.947)。区分度分析采用多时点ROC曲线计算1、3、5年生存率曲线下面积为0.907、0.935、0.921。校准曲线显示预测估计风险与实际观测结果有较好的准确度。  结论  Gal-3升高、室性心动过速、心尖部室壁瘤、运动负荷试验阳性与基于CMR参数中的LGE阳性是影响老年nHCM患者预后的独立危险因素;结合上述指标构建的诺莫图可以个体化评估老年nHCM患者的预后。

     

  • 图  1  老年nHCM患者预后预测模型诺莫图

    注:Points为子项得分;Total Points为总得分;X-year survival prob为X年生存率。

    Figure  1.  The nomogram of prognosis prediction model for elderly patients with nHCM

    图  2  诺莫图预测模型的tdROC曲线图

    Figure  2.  tdROC curve chart of nomogram forecast model

    图  3  诺莫图预测3年预后的校准曲线

    Figure  3.  Calibration curve of Nomogram predicting 3-year prognosis

    表  1  事件组与非事件组基线资料比较

    Table  1.   Comparison of baseline data between the event group and non-event group

    项目 非事件组(n=149) 事件组(n=30) 统计量 P
    年龄(x±s,岁) 70.1±6.9 69.9±6.1 0.166a 0.917
    性别(男性/女性,例) 87/62 15/15 0.416b 0.519
    猝死家族史[例(%)] 47(31.5) 11(36.7) 0.111b 0.739
    冠心病[例(%)] 43(28.9) 10(33.3) 0.073b 0.787
    慢性肾脏病[例(%)] 28(18.8) 4(13.3) 0.203b 0.652
    缺血性脑卒中[例(%)] 26(17.4) 4(13.3) 0.080b 0.777
    房颤/房扑[例(%)] 36(24.2) 7(23.3) 0.019b 0.999
    室性心动过速[例(%)] 24(16.1) 15(50.0) 14.903b < 0.001
    晕厥或先兆晕厥[例(%)] 17(11.4) 10(33.3) 0.545b 0.005
    脑利钠肽前体[M(P25, P75), ng/L] 534(417, 697) 604(408, 979) 0.455c 0.122
    超敏肌钙蛋白[M(P25, P75), μg/L] 0.73(0.56, 0.92) 0.84(0.66, 1.08) 0.173c 0.399
    Gal-3[M(P25, P75), μg/L] 4.32(3.72, 4.80) 6.26(5.47, 6.65) 2.118c < 0.001
    血尿素氮(x±s, mmol/L) 5.71±2.36 6.72±4.04 1.325a 0.194
    运动负荷试验阳性[例(%)] 12(8.1) 9(30.0) 0.582b 0.002
    肺动脉压升高[例(%)] 38(25.5) 8(26.7) 0.026b 0.999
    QTc间期[M(P25, P75), ms] 435(410, 473) 463(441, 493) 3.947c 0.010
    Tp-Te间期(x±s,ms) 102.0±18.1 99.4±13.3 0.892a 0.377
    LVEF(x±s,%) 53.7±8.4 47.9±3.8 5.942a < 0.001
    LAEDD[M(P25, P75), mm] 33.0(29.0, 39.0) 34.0(29.2, 40.4) 0.122c 0.496
    RAEDD[M(P25, P75), mm] 42.0(40.0, 43.0) 42.0(40.0, 44.8) 0.795c 0.421
    LVEDD(x±s,mm) 46.4±4.2 46.0±3.1 0.651a 0.518
    RVEDD[M(P25, P75), mm] 26.0(24.0, 28.0) 25.0(24.0, 27.0) 0.918c 0.300
    EDV(x±s,mL/m2) 147.0±22.8 151.0±22.4 0.858a 0.396
    ESV(x±s,mL/m2) 48.9±19.2 55.7±18.4 1.829a 0.074
    SV(x±s,mL/m2) 107.0±15.6 108.0±15.4 0.423a 0.674
    CO[M(P25, P75), L/min] 2.8(2.5, 3.4) 2.9(2.5, 3.4) 0.084c 0.685
    CI(x±s,L/min·m2) 2.9±0.7 2.9±0.7 0.212a 0.833
    LGE[例(%)] 91(61.1) 24(80.0) 3.114b 0.078
    室间隔肥厚[例(%)] 130(87.2) 24(80.0) 0.197b 0.384
    心尖部肥厚[例(%)] 14(9.4) 9(30.0) 0.536b 0.005
    左心室弥漫性肥厚[例(%)] 38(25.5) 10(33.3) 0.432b 0.511
    双心室肥厚[例(%)] 3(2.0) 2(6.7) 0.230b 0.196
    心尖部室壁瘤[例(%)] 1(0.7) 4(13.3) 0.512b 0.003
    注:at值,b为χ2值,cZ值。
    下载: 导出CSV

    表  2  影响老年nHCM患者OS的多因素Cox回归分析

    Table  2.   Multivariate Cox regression analysis of factors affecting OS in elderly patients with nHCM

    变量 β SE Waldχ2 P HR(95% CI)
    Gal-3 1.114 0.160 48.664 0.001 3.047(2.228~4.116)
    室性心动过速 0.995 0.406 6.012 0.014 2.705(1.221~5.991)
    LGE 1.008 0.504 3.996 0.046 2.740(1.020~7.360)
    运动负荷试验 1.013 0.446 5.153 0.023 2.753(1.148~6.601)
    心尖部室壁瘤 1.907 0.559 11.662 < 0.001 6.735(2.254~20.127)
    下载: 导出CSV
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  • 收稿日期:  2023-07-28
  • 网络出版日期:  2024-03-27

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