背景:由于左心疾病(pH-LHD)引起的肺动脉高压(pH)是临床实践中最常见的pH形式。
目的:研究的目的是开发一种结合常规无创检查和检测指标的诊断列线图预测模型。
方法:我们的研究回顾性纳入了361例左心疾病(LHD)患者,这些患者在2013年至2020年间接受了右心导管检查。将所有患者随机分为训练组(253,70%)和验证组(108,30%)。pH定义为通过RHC检查测量的静息平均肺动脉压(mPAP)≥25mmHg。采用Lasso回归模型进行数据降维和特征选择。基于多变量逻辑回归构建列线图。
结果:共有175例LHD患者在住院期间被诊断为pH值,占队列的48.5%。全组的平均年龄为55.6岁,76.7%为男性患者。过度的静息心率,提高了纽约心脏协会的功能类,红细胞分布宽度增加,右心室舒张末期直径,和通过超声心动图测量的肺动脉收缩压与pH-LHD的患病率独立相关。在列线图中包含这5个变量显示出良好的区分(AUC=0.866[95%CI,0.820-0.911])和最佳校准(Hosmer-Lemeshow检验,验证队列的P=0.791)。
结论:本研究建立的无创性pH-LHD列线图具有良好的诊断价值和临床适用性,并能更准确地评估LHD患者存在pH值的风险。
BACKGROUND: Pulmonary hypertension (pH) due to left heart disease (pH-LHD) is the most common form of pH in clinical practice.
OBJECTIVE: The purpose of the study is to develop a diagnostic nomogram predictive model combining conventional noninvasive examination and detection indicators.
METHODS: Our study retrospectively included 361 patients with left heart disease (LHD) who underwent right heart catheterization between 2013 and 2020. All patients were randomly divided into a training cohort (253, 70 %) and a validation cohort (108, 30 %). pH was defined as resting mean pulmonary arterial pressure (mPAP) ≥25 mmHg measured by RHC examination. Data dimension reduction and feature selection were used by Lasso regression model. The nomogram was constructed based on multivariable logistic regression.
RESULTS: A total of 175 patients with LHD were diagnosed with pH during their hospitalization, representing 48.5 % of the cohort. The mean age of the overall group was 55.6 years, with 76.7 % being male patients. Excessive resting heart rate, elevated New York Heart Association functional class, increased red blood cell distribution width, right ventricular end-diastolic diameter, and pulmonary artery systolic pressure measured by echocardiography were independently associated with the prevalence of pH-LHD. The inclusion of these 5 variables in the nomogram showed good discrimination (AUC = 0.866 [95 % CI, 0.820-0.911]) and optimal calibration (Hosmer-Lemeshow test, P = 0.791) for the validation cohort.
CONCLUSIONS: The noninvasive nomogram of pH-LHD developed in this study has excellent diagnostic value and clinical applicability, and can more accurately evaluate the presence risk of pH in patients with LHD.