Yang Lulu, Li Huan, Guo Guangli, Du Jiaqi, Hao Zhengyang, Kong Lingyao, Shi Huiting, Wang Xiaofang, Zhang Yanzhou
Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Front Cardiovasc Med. 2022 Apr 14;9:864366. doi: 10.3389/fcvm.2022.864366. eCollection 2022.
Heart failure with improved left ventricular ejection fraction (HFiEF) is linked to a good clinical outcome. The purpose of this study was to create an easy-to-use model to predict the occurrence of HFiEF in patients with heart failure (HF), 1 year after successful percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) (CTO PCI).
Patients diagnosed with HF who successfully underwent CTO PCI between January 2016 and August 2019 were included. To mitigate the effect of residual stenosis on left ventricular (LV) function, we excluded patients with severe residual stenosis, as quantitatively measured by a residual synergy between PCI with Taxus and Cardiac Surgery score (rSS) of >8. We gathered demographic data, medical history, angiographic and procedural characteristics, echocardiographic parameters, laboratory results, and medication information. The least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression models were used to identify predictors of HFiEF 1 year after CTO revascularization. A nomogram was established and validated according to the area under the receiver operating characteristic curve (AUC) and calibration curves. Internal validation was performed using bootstrap resampling.
A total of 465 patients were finally included in this study, and 165 (35.5%) patients experienced HFiEF 1 year after successful CTO PCI. According to the LASSO regression and multivariate logistic regression analyses, four variables were selected for the final prediction model: age [odds ratio (OR): 0.969; 95% confidence interval (CI): 0.952-0.988; = 0.001], previous myocardial infarction (OR: 0.533; 95% CI: 0.357-0.796; = 0.002), left ventricular end-diastolic dimension (OR: 0.940; 95% CI: 0.910-0.972; < 0.001), and sodium glucose cotransporter two inhibitors (OR: 5.634; 95% CI: 1.756-18.080; = 0.004). A nomogram was constructed to present the results. The C-index of the model was 0.666 (95% CI, 0.613-0.719) and 0.656 after validation. The calibration curve demonstrated that the nomogram agreed with the actual observations.
We developed an simple and effective nomogram for predicting the occurrence of HFiEF in patients with HF, 1 year after successful CTO PCI without severe residual stenosis.
左心室射血分数改善的心力衰竭（HFiEF）与良好的临床结局相关。本研究的目的是建立一个易于使用的模型，以预测慢性完全闭塞（CTO）患者成功进行经皮冠状动脉介入治疗（PCI）（CTO PCI）1年后发生HFiEF的情况。
纳入2016年1月至2019年8月间成功接受CTO PCI的心力衰竭患者。为减轻残余狭窄对左心室（LV）功能的影响，我们排除了严重残余狭窄患者，残余狭窄通过紫杉醇PCI与心脏手术评分（rSS）之间的残余协同效应定量测量，rSS>8。我们收集了人口统计学数据、病史、血管造影和手术特征、超声心动图参数、实验室检查结果和用药信息。使用最小绝对收缩和选择算子（LASSO）和多变量逻辑回归模型来识别CTO血运重建1年后HFiEF的预测因素。根据受试者工作特征曲线（AUC）下面积和校准曲线建立并验证列线图。使用自助重采样进行内部验证。
本研究最终共纳入465例患者，165例（35.5%）患者在成功进行CTO PCI 1年后发生HFiEF。根据LASSO回归和多变量逻辑回归分析，最终预测模型选择了四个变量：年龄[比值比（OR）：0.969；95%置信区间（CI）：0.952-0.988；P=0.001]、既往心肌梗死（OR：0.533；95%CI：0.357-0.796；P=0.002）、左心室舒张末期内径（OR：0.940；95%CI：0.910-0.972；P<0.001）和钠-葡萄糖协同转运蛋白2抑制剂（OR：5.634；95%CI：1.756-18.080；P=0.004）。构建列线图以展示结果。模型的C指数为0.666（95%CI，0.613-0.719），验证后为0.656。校准曲线表明列线图与实际观察结果相符。
我们开发了一个简单有效的列线图，用于预测无严重残余狭窄的CTO PCI成功后1年心力衰竭患者发生HFiEF的情况。
