Newly Developed Adult Congenital Heart Disease Anatomic and Physiological Classification: First Predictive Validity Evaluation
Newly Developed Adult Congenital Heart Disease Anatomic and Physiological Classification: First Predictive Validity Evaluation
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DOI：
10.1161/jaha.119.014988
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发表时间：
2020-03-03
影响因子：
5.4
通讯作者：
Moons, Philip
中科院分区：
文献类型：
--
作者：
Ombelet, Fouke;Goossens, Eva;Moons, Philip
成人先天性心脏病的危险分层通常是基于患者缺损的解剖复杂性。2018年美国心脏协会/美国心脏病学会成人先天性心脏病管理指南提出了一种新的分类方案，结合了患者的解剖复杂性和当前生理阶段。我们的目的是调查能力的成人先天性心脏病解剖和生理分类预测15年mortals.Methods和结果数据5分类系统收集了629例患者在门诊为以前的研究。15年后，通过病历审查获得死亡率数据。对于该评估，我们还收集了生理状态信息，以确定成人先天性心脏病解剖学和生理学分类。通过单变量考克斯比例风险回归获得的成人先天性心脏病解剖学和生理学分类的Harrell一致性统计指数为0.71（95% CI，0.63-0.78）。先天性心脏病解剖学成分的Harrell一致性统计指数为0.67（95%CI，0.60-0.74）。结合先天性心脏病功能指数获得的解剖复杂性的Harrell一致性统计指数最高（0.79; 95%可信区间，结论成人先天性心脏病解剖学和生理学分类系统的首次研究为在预测15- 18岁先天性心脏病的解剖学复杂性中增加生理学成分提供了经验支持。年心脏病死亡率。
Background Risk stratification for adults with congenital heart disease is usually based on the anatomic complexity of the patients' defect. The 2018 American Heart Association/American College of Cardiology guidelines for the management of adults with congenital heart disease proposed a new classification scheme, combining anatomic complexity and current physiological stage of the patient. We aimed to investigate the capacity of the Adult Congenital Heart Disease Anatomic and Physiological classification to predict 15-year mortality.Methods and Results Data on 5 classification systems were collected for 629 patients at the outpatient clinic for a previous study. After 15 years, data on mortality were obtained through medical record review. For this assessment, we additionally collected information on physiological state to determine the Adult Congenital Heart Disease Anatomic and Physiological classification. Harrell's concordance statistics index, obtained through a univariate Cox proportional hazards regression, was 0.71 (95% CI, 0.63-0.78) for the Adult Congenital Heart Disease Anatomic and Physiological classification. Harrell's concordance statistics index of the congenital heart disease anatomic component only was 0.67 (95% CI, 0.60-0.74). The highest Harrell's concordance statistics index was obtained for the anatomic complexity in combination with the Congenital Heart Disease Functional Index (0.79; 95% CI, 0.73-0.84).Conclusions This first investigation of the Adult Congenital Heart Disease Anatomic and Physiological classification system provides empirical support for adding the physiological component to the anatomic complexity in the prediction of 15-year cardiac mortality.