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识别非致密性心肌病患者心力衰竭合并心内血栓形成的危险因素并构建预测模型。

Identifying risk factors and constructing a predictive model for heart failure combined with intracardiac thrombus in non-compaction cardiomyopathy patients.

作者信息

Dang Peizhu, Wang Haiyang, Huo Xiaowei, Liang Zheyong, Zhang Yongjian

机构信息

Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China.

Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China.

出版信息

Sci Rep. 2025 Jan 16;15(1):2121. doi: 10.1038/s41598-025-85902-6.

DOI:10.1038/s41598-025-85902-6
PMID:39814828
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11735604/
Abstract

This study aims to develop a nomogram prediction model for assessing the cardiogenic composite endpoint, which includes intracardiac thrombosis (ICT) combined with heart failure (HF) in patients with non-compaction cardiomyopathy (NCM) patients. We retrospectively analyzed clinical data from NCM patients (January 2018 to May 2024), who were randomly assigned to training and validation cohorts. Independent predictors were identified using logistic regression, and a nomogram model was developed. The model's discriminative ability, accuracy, and clinical applicability were subsequently validated. A total of 976 patients were included, of whom 54 had ICT and 191 had HF. Diabetes mellitus (DM), left ventricular end-systolic diameter (LVESD), and ejection fraction (EF) were identified as independent predictors for the composite endpoint. The nomogram demonstrated good performance, with an area under the curve (AUC) of 0.747 (95% CI: 0.707-0.787) in the training group and 0.803 (95% CI: 0.752-0.854) in the validation group. The calibration curve for the training group showed an average absolute error of 0.028, with a Hosmer-Lemeshow test P-value of 0.076. Decision curve analysis and clinical impact curves further indicated that the clinical net benefit was maximized at a threshold probability of 0.05-0.61. This study establishes and validates a nomogram for predicting cardiogenic composite endpoint in NVM patients, demonstrating robust clinical predictive value.

摘要

本研究旨在开发一种列线图预测模型,用于评估心源性复合终点,该终点包括非致密化型心肌病(NCM)患者的心内血栓形成(ICT)合并心力衰竭(HF)。我们回顾性分析了NCM患者(2018年1月至2024年5月)的临床数据,这些患者被随机分配到训练队列和验证队列。使用逻辑回归确定独立预测因素,并开发列线图模型。随后对该模型的判别能力、准确性和临床适用性进行了验证。共纳入976例患者,其中54例有ICT,191例有HF。糖尿病(DM)、左心室收缩末期内径(LVESD)和射血分数(EF)被确定为复合终点的独立预测因素。列线图表现良好,训练组曲线下面积(AUC)为0.747(95%CI:0.707-0.787),验证组为0.803(95%CI:0.752-0.854)。训练组的校准曲线显示平均绝对误差为0.028,Hosmer-Lemeshow检验P值为0.076。决策曲线分析和临床影响曲线进一步表明,在阈值概率为0.05-0.61时临床净效益最大化。本研究建立并验证了用于预测NVM患者心源性复合终点的列线图,显示出强大的临床预测价值。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fa70/11735604/774cd8fec41f/41598_2025_85902_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fa70/11735604/774cd8fec41f/41598_2025_85902_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fa70/11735604/774cd8fec41f/41598_2025_85902_Fig4_HTML.jpg

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本文引用的文献

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[Analysis factors influencing left ventricular thrombus in patients with non-ischemic heart failure].[分析影响非缺血性心力衰竭患者左心室血栓形成的因素]
Zhonghua Xin Xue Guan Bing Za Zhi. 2024 Oct 24;52(10):1155-1161. doi: 10.3760/cma.j.cn112148-20240618-00335.
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Left Ventricular End-Systolic Diameter May Predict Persistent Heart Failure with Reduced Ejection Fraction.左心室收缩末期直径可能预测射血分数降低的持续性心力衰竭。
Int Heart J. 2023 Nov 30;64(6):1095-1104. doi: 10.1536/ihj.23-293. Epub 2023 Nov 14.
3
Clinical Relevance of the LVEDD and LVESD Trajectories in HF Patients With LVEF < 35.
射血分数<35%的心力衰竭患者左心室舒张末期内径和左心室收缩末期内径轨迹的临床相关性
Front Med (Lausanne). 2022 May 13;9:846361. doi: 10.3389/fmed.2022.846361. eCollection 2022.
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Relationship between intracoronary thrombus burden and systemic immune-inflammation index in patients with ST-segment elevation myocardial infarction.ST段抬高型心肌梗死患者冠状动脉内血栓负荷与全身免疫炎症指标的关系
Acta Cardiol. 2023 Feb;78(1):72-79. doi: 10.1080/00015385.2022.2035082. Epub 2022 Feb 1.
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Catheter Ablation of Life-Threatening Ventricular Arrhythmias in Athletes.运动员危及生命的室性心律失常的导管消融术
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Heart Failure With Reduced Ejection Fraction: A Review.射血分数降低型心力衰竭:综述。
JAMA. 2020 Aug 4;324(5):488-504. doi: 10.1001/jama.2020.10262.
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