Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Nutr Metab Cardiovasc Dis. 2024 Jun;34(6):1352-1360. doi: 10.1016/j.numecd.2024.01.017. Epub 2024 Jan 18.
Hypertrophic cardiomyopathy (HCM) causes cardiac death through both sudden cardiac death (SCD) and death due to heart failure (HF). Although adipokines lead to adverse cardiac remodeling in HCM, the prognostic value of plasma adipokines in HCM remains unknown. We aimed to predict cardiac death in patients with HCM using plasma adipokines.
We performed a multicenter prospective cohort study of patients with HCM. The outcome was cardiac death including heart transplant, death due to HF, and SCD. With data from 1 institution (training set), a prediction model was developed using random forest classification algorithm based on 10 plasma adipokines. The performance of the prediction model adjusted for 8 clinical parameters was examined in samples from another institution (test set). Time-to-event analysis was performed in the test set to compare the rate of outcome events between the low-risk and high-risk groups determined by the prediction model. In total, 389 (267 in the training set; 122 in the test set) patients with HCM were included. During the median follow-up of 2.7 years, 21 patients experienced the outcome event. The area under the covariates-adjusted receiver-operating characteristics curve was 0.89 (95 % confidence interval [CI] 0.71-0.99) in the test set. revealed the high-risk group had a significantly higher risk of cardiac death (hazard ratio 17.8, 95 % CI 2.1-148.3, P = 0.008).
The present multicenter prospective study demonstrated that a panel of plasma adipokines predicts cardiac death in patients with HCM.
肥厚型心肌病（HCM）可通过心源性猝死（SCD）和心力衰竭（HF）导致死亡。虽然脂肪因子可导致 HCM 发生不良心脏重构，但 HCM 患者血浆脂肪因子的预后价值仍不清楚。本研究旨在利用血浆脂肪因子预测 HCM 患者的心脏死亡。
我们进行了一项多中心前瞻性队列研究，纳入了 HCM 患者。研究终点为心脏死亡，包括心脏移植、HF 导致的死亡和 SCD。利用 1 个机构（训练集）的数据，我们采用随机森林分类算法基于 10 种血浆脂肪因子建立预测模型。我们在另一个机构（测试集）的样本中检验了调整 8 个临床参数后的预测模型的性能。在测试集中进行了生存分析，比较了预测模型确定的低危组和高危组的结局事件发生率。共纳入 389 例（训练集 267 例；测试集 122 例）HCM 患者。在 2.7 年的中位随访期间，21 例患者发生了结局事件。调整协变量后的接受者操作特征曲线下面积在测试集中为 0.89（95%置信区间 0.71-0.99）。研究结果显示，高危组心脏死亡风险显著更高（风险比 17.8，95%置信区间 2.1-148.3，P=0.008）。
本多中心前瞻性研究表明，一组血浆脂肪因子可预测 HCM 患者的心脏死亡。
