Li Zhitong, Liu Quanbo, Liu Fei, Hidru Tesfaldet H, Tang Yuqi, Cong Tao, Gao Lianjun, Yang Xiaolei, Xia Yunlong
Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China.
Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang, China.
Front Cardiovasc Med. 2021 Oct 14;8:737551. doi: 10.3389/fcvm.2021.737551. eCollection 2021.
The predictive power of the CHADS and CHADS-VASc scores for the presence of Left atrial thrombus (LAT)/ spontaneous echo contrast (SEC) in non-valvular atrial fibrillation (NVAF) is modest. The aim of this analysis is to define clinical and ultrasonic variables associated with LAT/SEC and to propose nomograms for individual risk prediction. Data on 1,813 consecutive NVAF patients who underwent transesophageal echocardiography (TEE) from January 2016 to January 2021 were collected. The univariate and multivariate logistic regression analyses were used to construct a nomogram. We examined the predictive ability of the risk scores by calculating the area under the curve (AUC). Moreover, the performance of the nomogram was assessed with respect to calibration, discrimination, and clinical usefulness. LAT/SEC was found in 260 (21.0%) and 124 (21.6%) patients in the training and validation cohorts, respectively. On multivariate analysis, independent factors for LAT/SEC were Age, left atrial diameter (LAD), left ventricular ejection fraction (LVEF), hypertension (HTN), previous stroke or transient ischemic attack, Non-paroxysmal AF and a nomogram was built based on these variables. The calibration curve for the probability of LAT/SEC showed good prediction agreement with actual observation. The nomogram achieved good concordance indexes of 0.836 and 0.794 in predicting LAT/SEC in the training and validation cohorts, respectively. Decision curve analysis demonstrated that the nomogram would be clinically useful. In this study, a nomogram was constructed that incorporated six characteristics of NVAF patients. The nomogram may be of great value for the prediction of LAT/SEC in NVAF patients.
CHADS和CHADS-VASc评分对非瓣膜性心房颤动（NVAF）患者左心房血栓（LAT）/自发显影（SEC）的预测能力一般。本分析旨在确定与LAT/SEC相关的临床和超声变量，并提出用于个体风险预测的列线图。收集了2016年1月至2021年1月期间连续1813例接受经食管超声心动图（TEE）检查的NVAF患者的数据。采用单因素和多因素逻辑回归分析构建列线图。通过计算曲线下面积（AUC）来检验风险评分的预测能力。此外，还从校准、区分度和临床实用性方面评估了列线图的性能。在训练队列和验证队列中，分别有260例（21.0%）和124例（21.6%）患者发现LAT/SEC。多因素分析显示，LAT/SEC的独立相关因素包括年龄、左心房直径（LAD）、左心室射血分数（LVEF）、高血压（HTN）、既往卒中或短暂性脑缺血发作、非阵发性房颤，并基于这些变量构建了列线图。LAT/SEC概率的校准曲线与实际观察结果显示出良好的预测一致性。该列线图在训练队列和验证队列中预测LAT/SEC的一致性指数分别为0.836和0.794。决策曲线分析表明该列线图具有临床实用性。在本研究中，构建了一个纳入NVAF患者六个特征的列线图。该列线图对预测NVAF患者的LAT/SEC可能具有重要价值。
