摘要
目的探究AVCS(主动脉瓣钙化积分)联合EuroSCOREⅡ预测经导管主动脉瓣置换术(TAVR)后的预后价值,建立预测模型对MACCE(主要不良心血管及脑血管事件)发生风险进行评估。方法回顾性收集2016年1月至2023年12月于新疆维吾尔自治区人民医院行TAVR治疗的重度主动脉瓣狭窄患者200例,收集患者的人口学、病史、检查结果、影像学参数等临床数据,由专科医师对心电图、超声心动图、CT血管造影(CTA)、手术资料等进行数据的提取和分析,构建MACCE的多因素Cox回归预测模型,使用ROC曲线分析预测能力的效能。结果在为期21个月的中位随访时间后,以TAVR术后MACCE作为结局事件,200例患者分为MACCE组(49例)和非MACCE组(151例)。TAVR术后MACCE发生率为24.5%,在MACCE组,其中全因死亡出现20例(10%),非致死性心肌梗死出现3例(1.5%),人工瓣膜血栓形成、瓣周漏、需要再次手术或介入治疗的瓣膜问题出现8例(4%),卒中出现7例(3.5%),因心脏原因(不稳定型心绞痛、慢性心力衰竭急性加重等)的计划外再住院出现11例(5.5%),MACCE组的高血压、糖尿病、二叶式瓣、中重度主动脉瓣钙化积分及EuroSCOREⅡ评分高危组的比例、年龄、肌酐均高于非MACCE组(P<0.05),差异均有统计学意义。Kaplan-Meier曲线分析显示,重度主动脉瓣钙化积分组TAVR术后的生存率明显降低(log-rank P<0.01),EuroSCOREⅡ评分高危组TAVR术后的生存率明显降低(log-rank P<0.01)。多因素Cox回归分析结果显示,民族(HR=0.278,95%CI 0.130~0.595,P=0.001)、高血压(HR=2.052,95%CI 1.023~4.119,P=0.043)、糖尿病(HR=1.912,95%CI 1.037~3.526,P=0.038)、EuroSCOREⅡ评分(HR=1.372,95%CI 1.080~1.742,P=0.010)、主动脉瓣钙化积分(HR=1.001,95%CI 1.000~1.002,P=0.016)是TAVR术后MACCE的独立危险因素,独立危险因素作为变量建立的预测模型,受试者工作特征曲线下面积为(ROC为0.72),可预测TAVR术后MACCE。结论作为新兴的评估工具,主动脉瓣钙化积分、EuroSCOREⅡ评分对主动脉瓣狭窄TAVR患者预后具有一定预测价值,且二者联合上述独立危险因素预测MACCE的效能较好、具有一定的临床效能。
Objective To investigate the prognostic value of aortic valve calcium score(AVCS)combined with EuroSCOREⅡin predicting major adverse cardiovascular and cerebrovascular events(MACCE)after transcatheter aortic valve replacement(TAVR)and to establish a predictive model for MACCE risk assessment.Methods 200 patients with severe aortic stenosis who underwent TAVR at the People’s Hospital of Xinjiang Uygur Autonomous Region from January 2016 to December 2023 were included.The demographic,clinical,imaging and surgical data were collected.The electrocardiograms,echocardiograms,CT angiography(CTA)and procedural records were analyzed by the Specialists.A multivariate Cox regression model was constructed to identify the predictors of MACCE,and the predictive performance was evaluated using receiver operating characteristic(ROC)curve analysis.Result After a median follow-up of 21 months,49 patients(24.5%)experienced MACCE,including 20 cases of all-cause mortality(10%),3 non-fatal myocardial infarctions(1.5%),8 valve-related complications(thrombosis,paravalvular leak,or reintervention;4%),7 strokes(3.5%)and 11 unplanned cardiac-related hospitalizations(5.5%).The MACCE group had higher proportions of hypertension,diabetes,bicuspid valves,moderate-to-severe aortic valve calcification,high-risk EuroSCOREⅡscores,with older age and elevated creatinine levels compared to the non-MACCE group(P<0.05).Kaplan-Meier analysis revealed a significantly reduced survival in patients with severe aortic calcification(log-rank P<0.01)and high EuroSCOREⅡscores(log-rank P<0.01).Multivariate Cox regression identified ethnicity(HR=0.278,95%CI 0.130-0.595,P=0.001),hypertension(HR=2.052,95%CI 1.023-4.119,P=0.043),diabetes(HR=1.912,95%CI 1.037-3.526,P=0.038),EuroSCOREⅡ(HR=1.372,95%CI 1.080-1.742,P=0.010)and AVCS(HR=1.001,95%CI 1.000-1.002,P=0.016)as the independent risk factors for MACCE.The predictive model incorporating these factors achieved an area under the ROC curve of 0.72.Conclusion As emerging assessment tools,the aortic valve calcification score and EuroSCOREⅡscore have been shown to possess a certain degree of predictive value in relation to the prognosis of TAVR patients suffering from aortic stenosis.Furthermore,the efficacy of these two tools in combination with the independent risk factors mentioned above in predicting major adverse cardiovascular events(MACCE)has been demonstrated to be superior,thus indicating a certain degree of clinical efficacy.
作者
杨帆
郑峥
陶静
杨毅宁
YANG Fan;ZHENG Zheng;TAO Jing;YANG Yi-ning(Medical College,Shihezi University,Shihezi 832003,China;Department of Radiology,People’s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830000,China;Xinjiang Key Laboratory of Cardiovascular Homeostasis and Regeneration Research,Urumqi 830000,China)
出处
《中国心血管病研究》
2025年第2期126-132,共7页
Chinese Journal of Cardiovascular Research
基金
新疆维吾尔自治区天山英才培养计划项目(2022TSYCLJ0028)。
