Yousef Sameh, Amabile Andrea, Ram Chirag, Huang Huang, Korutla Varun, Singh Saket, Agarwal Ritu, Assi Roland, Milewski Rita K, Zhang Yawei, Patel Prakash A, Krane Markus, Geirsson Arnar, Vallabhajosyula Prashanth
Division of Cardiac Surgery, Yale School of Medicine, 330 Cedar Street BB204, New Haven, CT 06511, USA.
Section of Surgical Outcomes and Epidemiology, Yale School of Public Health, New Haven, CT 06511, USA.
J Clin Med. 2022 Jul 28;11(15):4386. doi: 10.3390/jcm11154386.
(1) Background: The clinical burden of aortic stenosis (AS) remains high in Western countries. Yet, there are no screening algorithms for this condition. We developed a risk prediction model to guide targeted screening for patients with AS. (2) Methods: We performed a cross-sectional analysis of all echocardiographic studies performed between 2013 and 2018 at a tertiary academic care center. We included reports of unique patients aged from 40 to 95 years. A logistic regression model was fitted for the risk of moderate and severe AS, with readily available demographics and comorbidity variables. Model performance was assessed by the C-index, and its calibration was judged by a calibration plot. (3) Results: Among the 38,788 reports yielded by inclusion criteria, there were 4200 (10.8%) patients with ≥moderate AS. The multivariable model demonstrated multiple variables to be associated with AS, including age, male gender, Caucasian race, Body Mass Index ≥ 30, and cardiovascular comorbidities and medications. C-statistics of the model was 0.77 and was well calibrated according to the calibration plot. An integer point system was developed to calculate the predicted risk of ≥moderate AS, which ranged from 0.0002 to 0.7711. The lower 20% of risk was approximately 0.15 (corresponds to a score of 252), while the upper 20% of risk was about 0.60 (corresponds to a score of 332 points). (4) Conclusions: We developed a risk prediction model to predict patients' risk of having ≥moderate AS based on demographic and clinical variables from a large population cohort. This tool may guide targeted screening for patients with advanced AS in the general population.
(1)背景:在西方国家,主动脉瓣狭窄(AS)的临床负担仍然很高。然而,目前尚无针对这种疾病的筛查算法。我们开发了一种风险预测模型,以指导对AS患者进行有针对性的筛查。(2)方法:我们对2013年至2018年在一家三级学术医疗中心进行的所有超声心动图研究进行了横断面分析。我们纳入了年龄在40至95岁之间的独特患者的报告。采用逻辑回归模型来评估中度和重度AS的风险,纳入易于获取的人口统计学和合并症变量。通过C指数评估模型性能,并通过校准图判断其校准情况。(3)结果:在符合纳入标准的38788份报告中,有4200名(10.8%)患者患有≥中度AS。多变量模型显示多个变量与AS相关,包括年龄、男性、白种人、体重指数≥30以及心血管合并症和用药情况。该模型的C统计量为0.77,根据校准图校准良好。开发了一个整数评分系统来计算≥中度AS的预测风险,范围从0.0002到0.7711。风险最低的20%约为0.15(对应分数为252分),而风险最高的20%约为0.60(对应分数为332分)。(4)结论:我们基于来自大量人群队列的人口统计学和临床变量,开发了一种风险预测模型,以预测患者患有≥中度AS的风险。该工具可为普通人群中晚期AS患者的靶向筛查提供指导。