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建立一个列线图用于筛查中国高血压患者左心室肥厚的风险。

Development of a nomogram for screening the risk of left ventricular hypertrophy in Chinese hypertensive patients.

机构信息

Department of Geriatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.

Fujian Hypertension Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.

出版信息

J Clin Hypertens (Greenwich). 2021 Jun;23(6):1176-1185. doi: 10.1111/jch.14240. Epub 2021 Mar 26.

Abstract

Left ventricular hypertrophy (LVH) is an important risk factor for cardiovascular morbidity and mortality in hypertensives. Therefore, early identification of at-risk patients is necessary. The objective of this study was to estimate the risk of LVH among Chinese hypertensives by designing a nomogram. 832 hypertensives were divided into two groups based on the presence of LVH. The least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression were successively applied for optimal variable selection and nomogram construction. Discrimination power, calibration, and clinical usefulness were evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis. Internal validation was performed using the bootstrap method. The nomogram included five predictors, namely gender, duration of hypertension, age, body mass index (BMI), and systolic blood pressure. The area under the ROC curve (AUC) was 0.724 (95% CI: 0.687-0.761), indicating moderate discrimination. The calibration curve showed an excellent agreement between the predicted LVH and the actual LVH probability. The risk threshold between 5% and 72% according to the decision curve analysis, and the nomogram is clinically beneficial. Internal validation by bootstrapping with 1000 samples showed a good C-index of 0.715, which suggested that the predictive abilities for the training set and testing set were in consistency. Our study proposed a nomogram that can be utilized to assess the LVH risk rapidly for Chinese hypertensives. This tool could be useful in identifying patients at high risk for LVH. Further studies are required to ascertain the stability and applicability of this nomogram.

摘要

左心室肥厚(LVH)是高血压患者心血管发病率和死亡率的重要危险因素。因此,早期识别高危患者是必要的。本研究旨在通过设计列线图来估计中国高血压患者发生 LVH 的风险。根据是否存在 LVH,将 832 例高血压患者分为两组。先后应用最小绝对值收缩和选择算子(LASSO)回归和多变量逻辑回归进行最优变量选择和列线图构建。使用受试者工作特征(ROC)曲线、校准曲线和决策曲线分析评估判别能力、校准和临床实用性。采用自举法进行内部验证。该列线图包括 5 个预测因子,即性别、高血压持续时间、年龄、体重指数(BMI)和收缩压。ROC 曲线下面积(AUC)为 0.724(95%CI:0.687-0.761),表明中等程度的判别力。校准曲线显示预测 LVH 与实际 LVH 概率之间有极好的一致性。根据决策曲线分析,风险阈值在 5%到 72%之间,列线图具有临床获益。通过 1000 个样本进行自举验证,C 指数为 0.715,表明训练集和测试集的预测能力具有一致性。本研究提出了一种列线图,可以快速评估中国高血压患者的 LVH 风险。该工具可用于识别 LVH 风险较高的患者。需要进一步的研究来确定该列线图的稳定性和适用性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1c11/8678799/4351722c7658/JCH-23-1176-g004.jpg

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