Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Faculty of Health Science, University of Southern Denmark, Odense, Denmark; OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
Department of Cardiology, Odense University Hospital, Odense, Denmark.
Am J Cardiol. 2023 Dec 15;209:165-172. doi: 10.1016/j.amjcard.2023.09.068. Epub 2023 Oct 28.
The 12-item version of the Kansas City Cardiomyopathy Questionnaire (KCCQ-12) was originally developed for patients with heart failure but has been used and tested among patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve implantation. Whether the instrument is suitable for patients with AS who underwent surgical aortic valve replacement (SAVR) is currently unknown. Thus, we aimed to investigate the psychometric properties of the KCCQ-12 before and after SAVR among patients with severe AS. We conducted a prospective cohort of 184 patients with AS who completed the KCCQ-12 and the EuroQol 5 Dimension 5 Levels before and 4 weeks after surgery. Construct validity was investigated with hypothesis testing and an analysis of Spearman's correlation between the two instruments. Structural validity was investigated with explorative and confirmatory factor analyses and reliability with Cronbach's α. All analyses were conducted on data from the two time points (preoperatively and four weeks after surgery). The hypothesis testing revealed how the New York Heart Association class was significantly correlated with the preoperative KCCQ-12 total score (higher New York Heart Association class, worse score). A longer length of hospital stay and living alone were significantly associated with poorer postoperative KCCQ-12 total score. KCCQ-12 and EuroQol 5 Dimension 5 Levels were moderately correlated in most domains/the total score/Visual Analogue Scale score. Principal component analyses revealed two 3-factor structures. The confirmatory factor analyses did not support the original model at any time point. Cronbach's α ranged from 0.22 to 0.84 in three preoperative factors and from 0.39 to 0.76 in the postoperative factors. The total Cronbach's α was 0.83 for the suggested preoperative 3-factor model and 0.83 for the postoperative model. In conclusion, the Danish version of the KCCQ-12 tested in a population of patients with AS who underwent SAVR appears to have acceptable construct validity, whereas structural validity cannot be confirmed for the original four-factor model. Overall reliability is good.
堪萨斯城心肌病问卷（KCCQ-12）的 12 项版本最初是为心力衰竭患者开发的，但已在接受经导管主动脉瓣植入术的严重主动脉瓣狭窄（AS）患者中使用和测试。该工具是否适用于接受主动脉瓣置换术（SAVR）的 AS 患者目前尚不清楚。因此，我们旨在研究严重 AS 患者接受 SAVR 前后 KCCQ-12 的心理测量特性。我们进行了一项前瞻性队列研究，共纳入 184 例 AS 患者，他们在手术前和手术后 4 周完成了 KCCQ-12 和 EuroQol 5 维度 5 级量表。通过假设检验和两种仪器之间 Spearman 相关分析来研究结构效度。通过探索性和验证性因子分析以及 Cronbach's α 来研究结构效度。所有分析均基于两个时间点（术前和术后 4 周）的数据进行。假设检验显示纽约心脏协会（NYHA）分级与术前 KCCQ-12 总分之间存在显著相关性（NYHA 分级越高，得分越差）。住院时间较长和独居与术后 KCCQ-12 总分较差显著相关。KCCQ-12 和 EuroQol 5 维度 5 级量表在大多数领域/总分/视觉模拟量表得分中呈中度相关。主成分分析显示两个三因素结构。在任何时间点，验证性因子分析均不支持原始模型。术前三个因素的 Cronbach's α 范围为 0.22 至 0.84，术后因素的 Cronbach's α 范围为 0.39 至 0.76。术前三因素模型和术后模型的总 Cronbach's α 分别为 0.83。总之，在接受 SAVR 的 AS 患者人群中测试的丹麦版 KCCQ-12 似乎具有可接受的结构效度，而对于原始的四因素模型，结构效度无法得到证实。整体可靠性良好。
