慢性血栓栓塞性肺动脉高压患者球囊肺动脉血管成形术相关并发症列线图的开发与验证
Development and Validation of a Nomogram for Balloon Pulmonary Angioplasty-Related Complications in Patients with Chronic Thromboembolic Pulmonary Hypertension.
作者信息
Li Xin, Zhang Yi, Jin Qi, Luo Qin, Zhao Qing, Yang Tao, Zeng Qixian, Duan Anqi, Huang Zhihua, Hu Meixi, Zhang Sicheng, Gao Luyang, Xiong Changming, Zhao Zhihui, Liu Zhihong
机构信息
Center for Respiratory and Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China.
Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, 200032 Shanghai, China.
出版信息
Rev Cardiovasc Med. 2023 Feb 28;24(3):72. doi: 10.31083/j.rcm2403072. eCollection 2023 Mar.
BACKGROUND
Balloon pulmonary angioplasty (BPA)-related complications are not uncommon and could contribute to perioperative mortality. However, there is a lack of a prediction model for BPA-related complications.
METHODS
Data from consecutive patients diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) who underwent BPA were retrospectively analyzed. The primary outcome was BPA-related complications. The secondary outcomes were mortality and hemodynamics after BPA.
RESULTS
A total of 207 patients with 614 BPA sessions were included. Complications occurred during 63 sessions (10.26%) in 49 patients. Hemoptysis or hemosputum (6.51%) was the most common complication, whereas pulmonary reperfusion edema was rare (0.49%). Multivariable logistic regression identified that disease duration, mean pulmonary arterial pressure (mPAP) and the proportion of occlusion lesions were correlated with BPA complications. A nomogram was constructed accordingly, which had the highest area under curve (0.703) and was superior to previously reported predictors [nomogram vs. mPAP, net reclassification index (95% confidence interval (CI)), 0.215 (0.002, 0.427), = 0.047; integrated discrimination index (95% CI), 0.059 (0.010, 0.109), = 0.018]. The nomogram was found to be accurate based on validation and calibration (slope 0.978, Bier score 0.163). After adjusting for the number of BPA sessions in multivariable linear regression, the occurrence of complications was not associated with hemodynamic improvement after BPA. The 3-year survival was also comparable between patients with and without complications (98.0% vs. 94.8%, log-rank = 0.503).
CONCLUSIONS
The nomogram, comprising mPAP, the proportion of occlusion lesions and disease duration, could better predict BPA-related complications than previously reported single parameters. Distinctively, the occurrence of complications did not impair the beneficial impact of BPA on hemodynamics and survival. The occurrence of complications should not discourage patients from continuing BPA sessions.
背景
球囊肺动脉血管成形术（BPA）相关并发症并不少见，可能导致围手术期死亡率。然而，目前缺乏针对BPA相关并发症的预测模型。
方法
对连续接受BPA治疗的慢性血栓栓塞性肺动脉高压（CTEPH）患者的数据进行回顾性分析。主要结局为BPA相关并发症。次要结局为BPA后的死亡率和血流动力学情况。
结果
共纳入207例患者，进行了614次BPA治疗。49例患者的63次治疗（10.26%）出现并发症。咯血或痰中带血（6.51%）是最常见的并发症，而肺再灌注水肿少见（0.49%）。多变量逻辑回归分析显示，病程、平均肺动脉压（mPAP）和闭塞病变比例与BPA并发症相关。据此构建了列线图，其曲线下面积最大（0.703），优于先前报道的预测指标[列线图与mPAP比较，净重新分类指数（95%置信区间（CI）），0.215（0.002，0.427），P = 0.047；综合判别指数（95%CI），0.059（0.010，0.109），P = 0.018]。经验证和校准，列线图被证明是准确的（斜率0.978，Bier评分0.163）。在多变量线性回归中校正BPA治疗次数后，并发症的发生与BPA后血流动力学改善无关。有并发症和无并发症患者的3年生存率也相当（98.0%对94.8%，对数秩检验P = 0.503）。
结论
由mPAP、闭塞病变比例和病程组成的列线图比先前报道的单一参数能更好地预测BPA相关并发症。特别的是，并发症的发生并未削弱BPA对血流动力学和生存的有益影响。并发症的发生不应阻碍患者继续进行BPA治疗。
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