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

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

刘磊¹,
李天娇²,
孙宾³,
任宏强^1, ,

1.
遂宁市中心医院心血管中心，四川遂宁 629000
2.
遂宁市中心医院医学影像中心
3.
南充市中心医院心血管内科，四川南充 637000

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
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- 文章访问数: 177
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- 被引次数: 0
出版历程
- 收稿日期: 2023-07-28
- 网络出版日期: 2024-03-27

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

1.
Department of Cardiology, Suining Central Hospital, Suining, Sichuan 629000, China

摘要

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。
- 非梗阻性肥厚型心肌病 /
- 心脏磁共振 /
- 诺莫图 /
- 预后
Abstract: Objective To investigate the survival prognosis of elderly patients with non-obstructive hypertrophic cardiomyopathy (nHCM), and to establish a nomogram based on cardiac magnetic resonance (CMR) parameters and clinical characteristics to predict the overall survival (OS) of patients with nHCM. Methods A total of 179 patients with nHCM admitted to the Cardiovascular Center of Suining Central Hospital and Nanchong Central Hospital from June 2015 to November 2021 were retrospectively analyzed. Multivariate Cox regression analysis was used to determine the independent prognostic factors associated with OS and nomogram was drawn. The internal validation was performed by Bootstrap. Results Multivariate Cox regression analysis showed that the prognostic factors were galectin-3 (Gal-3), ventricular tachycardia, apical aneurysm, late gadolinium enhancement (LGE), exercise stress test. The Bootstrap correction value of c-index was 0.908(95% CI: 0.869-0.947); The area under the curve of 1, 3, and 5-year survival rate calculated by multi time point ROC curve were 0.907, 0.935, and 0.921 for discrimination analysis. The calibration curve showed that the predicted estimated risk had good accuracy with the actual observation results. Conclusion The elevation of Gal-3, ventricular tachycardia, apical ventricular aneurysm, positive exercise stress test, and positive LGE based on CMR parameters are independent risk factors that affect the prognosis of elderly nHCM patients. The nomogram constructed based on the above indicators can be used to individualize the assessment of the prognosis of elderly nHCM patients.
- Non obstructive hypertrophic cardiomyopathy /
- Cardiac magnetic resonance /
- Nomogram /
- Prognosis

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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

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图 2 诺莫图预测模型的tdROC曲线图

Figure 2. tdROC curve chart of nomogram forecast model

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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

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

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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值	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)

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