Nomogram Predicts Improvement of Ischemic Mitral Regurgitation After Coronary Artery Bypass Grafting
Nomogram Predicts Improvement of Ischemic Mitral Regurgitation After Coronary Artery Bypass Grafting
复制标题
列线图预测冠状动脉搭桥术后缺血性二尖瓣反流的改善。
DOI：
10.1016/j.athoracsur.2021.09.037
复制
发表时间：
2022-10-21
影响因子：
4.6
通讯作者：
Sun，Xiaotian
中科院分区：
文献类型：
--
作者：
Huang，Kai;Wang，Yiqing;Sun，Xiaotian
背景需要开发列线图来预测冠状动脉旁路移植术（CABG）后中度缺血性二尖瓣反流（IMR）的改善。方法我们回顾性收集了 2010 年至 2018 年间接受 CABG 的 112 例既往心肌梗死且中度 IMR 患者的数据。根据 CABG 后 1 年的 IMR 程度将患者分为 2 组，如下： 无或轻度 IMR 改善组（n = 54) 和中度或重度 IMR 失败组 (n = 58)。为了确定术后 IMR 改善的预测因素，比较了术前临床和超声心动图数据，并根据所有独立预测因素制定了列线图。对预测模型的判别能力、校准和临床实用性进行了评估。 结果 CABG 构建列线图后 IMR 改善的独立预测因素包括梗死和手术之间的持续时间、后下心室与左心室容积比、16 节段达到最小收缩容积的时间的最大差值、P3 瓣叶栓系角和环形非平面角。列线图表现出拟合良好的校准曲线和出色的判别能力。受试者工作特征曲线下面积为 0.974。得分 >236 的患者表现出 IMR 改善的可能性很高（敏感性，90.7%；特异性，93.1%）。改善组的患者比失败组的患者表现出更高的精算生存率。结论结合 5 个术前临床和超声心动图预测因子的列线图提供了手术后 IMR 适度改善的准确术前估计，具有出色的辨别能力。根据该列线图，得分较高的患者预测 IMR 改善的可能性较高。
BackgroundDeveloping a nomogram to predict improvement in moderate ischemic mitral regurgitation (IMR) after coronary artery bypass grafting (CABG) is in need.MethodsWe retrospectively collected data from 112 patients with prior myocardial infarction and moderate IMR undergoing CABG between 2010 and 2018. Patients were divided into 2 groups based on IMR degree 1 year after CABG as follows: Improved Group with no or mild IMR (n = 54) and Failure Group with moderate or severe IMR (n = 58). To determine the predictors of postoperative IMR improvement, preoperative clinical and echocardiographic data were compared, and a nomogram was formulated based on all independent predictors. Discriminative ability, calibration, and clinical usefulness of the prediction model were assessed.ResultsIndependent predictors of IMR improvement after CABG constructing the nomogram included duration between infarction and operation, posterior-inferior to left ventricular volume ratio, maximum difference of the time to reach minimum systolic volume of 16 segments, P3 leaflet tethering angle, and annular nonplanar angle. The nomogram exhibited well-fitted calibration curves and excellent discriminative ability. The area under the receiver operating characteristic curve was 0.974. Patients with a score >236 demonstrated a high probability of IMR improvement (sensitivity, 90.7%; specificity, 93.1%). Patients in the Improved Group demonstrated greater actuarial survival rates than those in the Failure Group.ConclusionsThe nomogram combining 5 preoperative clinical and echocardiographic predictors provides an accurate preoperative estimation of moderate IMR improvement after surgery, with excellent discriminative ability. Based on this nomogram, patients with a higher score have predicted higher probabilities of IMR improvement.