摘要
目的探讨心脏核磁(cardiac magnetic resonance,CMR)评估冠心病(coronary artery disease,CAD)合并射血分数降低型心衰(heart failure with reduced ejection fraction,HFrEF)患者外科治疗围手术期风险的应用价值。方法回顾性纳入2018年1月至2021年10月在北京安贞医院诊断为CAD合并HFrEF行单纯冠状动脉旁路移植术的78例患者,所有患者术前均行CMR检查,收集临床资料,根据围手术期是否出现主要心脑血管不良事件(major adverse cardiac and cerebrovascular events,MACCE)分为两组,比较两组患者术前、术中资料,通过LASSO回归筛选可能导致围手术期MACCE发生的危险因素,Logistic回归建立预测模型并进行内部验证,评价模型诊断效能及准确性。结果出现围手术期MACCE患者24例(30.8%),无围手术期MACCE患者54例(69.2%)。通过LASSO回归筛选出3个与结局相关的因素,经多因素logistic回归分析后发现,左心室第3节段、第8节段谍延迟钆增加(LGE)以及舒张期径向应变率是发生围手术期MACCE的独立危险因素。结合CMR构建的预测模型曲线下面积为0.799(95%CI:0.696~0.901),区分度良好,校准曲线显示,预测曲线与标准曲线基本拟合,Hosmer-Lemeshow检验P=0.797,预测准确度较高。结论CMR对冠心病合并HFrEF患者围手术期风险有较高的预测价值,结合CMR建立风险预测模型,可为评估该类患者外科治疗围手术期风险提供一定参考。
ObjectiveTo investigate the application value of cardiac magnetic resonance imaging(CMR)in evaluating the perioperative risk of surgical treatment in patients of coronary artery disease and heart failure with reduced ejection fraction.MethodsA total of 78 patients diagnosed with CAD and HFrEF who underwent CABG in Beijing Anzhen Hospital from January 2018 to October 2021 were retrospectively enrolled.All patients underwent CMR examination before CABG.The perioperative data of the two groups were compared,and the risk factors that may lead to perioperative MACCE were analyzed by LASSO regression.Then,logistic regression was used to establish a prediction model and internal validation was performed to evaluate the diagnostic efficiency and accuracy of the model by Bootstrap method.ResultsThere were 24 patients(30.8%)with perioperative MACCE and 54 patients(69.2%)without perioperative MACCE.LASSO regression was used to screen out three factors related to the outcome.Multivariate logistic regression analysis showed that LGE in the third and eighth segment of left ventricle and diastolic radial strain rate were independent risk factors for perioperative MACCE.The area under the curve of the prediction model constructed with CMR was 0.799(95%CI:0.696-0.901),so the discrimination was good.The calibration curve showed that the prediction curve was basically fit to the standard curve,and the Hosmer-Lemeshow test P=0.797,indicating high prediction accuracy.ConclusionCMR is a valuable test for evaluating perioperative risk in patients with coronary heart disease complicated with HFrEF.To establish the risk prediction model combined with CMR can provide some reference for the assessment of perioperative risk in these patients undergoing surgical treatment.
作者
张魁
刘恺闻
付威
张宏凯
郑居兵
孙逸平
吴立松
刘韬帅
董然
Zhang Kui;Liu Kaiwen;Fu Wei;Zhang Hongkai;Zheng Jubing;Sun Yiping;Wu Lisong;Liu Taoshuai;Dong Ran(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Capital Medical University,Beijing 100069,China;Department of Imaging,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)
出处
《中华胸心血管外科杂志》
2025年第1期22-29,共8页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
国家自然科学基金(82270408)
首都医学科学创新中心(CX23YZ08)。
关键词
冠心病
心衰
心脏磁共振
冠状动脉旁路移植术
Coronary heart disease
Heart failure
Cardiac magnetic resonance imaging
Coronary artery bypass grafting
