Evans William, Akyea Ralph Kwame, Weng Stephen, Kai Joe, Qureshi Nadeem
Primary Care Stratified Medicine (PRISM), Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK.
Statistical Decision Sciences, Cardiovascular and Metabolism, Janssen Research and Development, High Wycombe HP12 4EG, UK.
J Pers Med. 2022 Aug 5;12(8):1290. doi: 10.3390/jpm12081290.
Bicuspid aortic valve disease (BAV) is the most common congenital heart condition, and early detection can improve outcomes for patients. In this case−control study, patients with a diagnosis of BAV were identified from their electronic primary-care records in the UK’s Clinical Practice Research Datalink (CPRD). Each case was propensity-score matched to up to five controls. The clinical features recorded before diagnosis were compared. The proposed clinical features shown to be associated with BAV (p < 0.05) were incorporated into a multivariable regression model. We identified 2898 cases. The prevalence of BAV in the CPRD was 1 in 5181, significantly lower than expected, suggesting that diagnosis and/or recording could be improved. The following biologically plausible clinical features were associated with a subsequent diagnosis of BAV: palpitations (OR: 2.86 (95% CI: 1.60, 3.16)), atrial fibrillation (AF) (OR: 2.25 (95% CI: 1.60, 3.16)) and hypertension (OR: 1.72 (1.48, 2.00)). The best model had an AUC of 0.669 (95% CI: 0.658 to 0.680), a positive predictive value (PPV) of 5.9% (95% CI: 4.0% to 8.7%) and a negative predictive value (NPV) of 99% (95% CI: 99% to 99%) at a population prevalence of 1%. This study indicates that palpitations, hypertension and AF should trigger a clinical suspicion of BAV and assessment via echocardiography. It also demonstrates the potential to develop a prediction model for BAV to stratify patients for echocardiography screening.
二叶式主动脉瓣疾病（BAV）是最常见的先天性心脏病，早期检测可改善患者的预后。在这项病例对照研究中，从英国临床实践研究数据链（CPRD）的电子初级保健记录中识别出诊断为BAV的患者。每个病例与多达五个对照进行倾向评分匹配。比较诊断前记录的临床特征。将显示与BAV相关（p<0.05）的拟议临床特征纳入多变量回归模型。我们识别出2898例病例。CPRD中BAV的患病率为1/5181，显著低于预期，表明诊断和/或记录可能需要改进。以下具有生物学合理性的临床特征与随后的BAV诊断相关：心悸（OR：2.86（95%CI：1.60，3.16））、心房颤动（AF）（OR：2.25（95%CI：1.60，3.16））和高血压（OR：1.72（1.48，2.00））。在人群患病率为1%时，最佳模型的曲线下面积（AUC）为0.669（95%CI：0.658至0.680），阳性预测值（PPV）为5.9%（95%CI：4.0%至8.7%），阴性预测值（NPV）为99%（95%CI：99%至99%）。这项研究表明，心悸、高血压和AF应引发对BAV的临床怀疑，并通过超声心动图进行评估。它还证明了开发BAV预测模型以对患者进行超声心动图筛查分层的潜力。
