Chinese General Practice ›› 2023, Vol. 26 ›› Issue (08): 917-926.DOI: 10.12114/j.issn.1007-9572.2022.0592
Special Issue: 心血管最新文章合集
• Original Research • Previous Articles Next Articles
Received:
2022-04-12
Revised:
2022-10-10
Published:
2023-03-15
Online:
2022-11-24
Contact:
HE Sen
通讯作者:
何森
作者简介:
基金资助:
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URL: https://www.chinagp.net/EN/10.12114/j.issn.1007-9572.2022.0592
变量 | 定义 | 赋值原则 |
---|---|---|
年龄 | 首次评估时的年龄[ | 连续性变量:岁 |
既往TE事件 | 根据CHA2DS2-VASc评分模型中的相关定义,为:缺血性脑卒中、短暂性脑缺血发作或外周动脉栓塞[ | 二分类变量:是/否 |
血管疾病 | 根据CHA2DS2-VASc评分模型中的相关定义,为:陈旧心肌梗死、外周动脉疾病或主动脉斑块[ | 二分类变量:是/否 |
高血压 | 血压值持续或非同日3次以上超过标准血压,即3次非同日收缩压≥140 mm Hg和/或舒张压≥90 mm Hg者,则诊断高血压;如既往诊断高血压,目前服用药物情况下血压处于参考范围,也诊断为高血压[ | 二分类变量:是/否 |
糖尿病 | 空腹血糖水平≥7 mmol/L,或有医生诊断的糖尿病史,或服用降糖药物[ | 二分类变量:是/否 |
心房颤动 | 诊断依据:存在心房颤动病史,或常规心电图提示心房颤动,或动态心电图提示心房颤动[ | 二分类变量:是/否 |
MWT | 超声心动图测定的MWT | 连续性变量:mm |
LA内径 | 超声心动图测定的LA前后径 | 连续性变量:mm |
LVOTO | 左心室流出道静息压力阶差≥30 mm Hg[ | 二分类变量:是/否 |
NYHA心功能分级 | Ⅰ级:有心脏病但体力活动不受限制;日常体力活动不引起明显的疲乏、心悸、呼吸困难、心绞痛等症状 | 二分类变量:Ⅲ/Ⅳ级为是,Ⅰ/Ⅱ级为否 |
Ⅱ级:体力活动轻度受限;休息时无自觉症状,日常活动可出现较明显的上述症状,休息后很快缓解 | ||
Ⅲ级:体力活动明显受限;休息时可无症状,轻于日常活动即引起上述症状,休息较长时间后方可缓解 | ||
Ⅳ级:不能从事任何体力活动;休息时亦有心衰的症状,体力活动后明显加重 | ||
LVEF | 超声心动图测定的左心室射血分数 | 连续性变量:% |
Table 1 Definitions and weight assignment principles of candidate variables
变量 | 定义 | 赋值原则 |
---|---|---|
年龄 | 首次评估时的年龄[ | 连续性变量:岁 |
既往TE事件 | 根据CHA2DS2-VASc评分模型中的相关定义,为:缺血性脑卒中、短暂性脑缺血发作或外周动脉栓塞[ | 二分类变量:是/否 |
血管疾病 | 根据CHA2DS2-VASc评分模型中的相关定义,为:陈旧心肌梗死、外周动脉疾病或主动脉斑块[ | 二分类变量:是/否 |
高血压 | 血压值持续或非同日3次以上超过标准血压,即3次非同日收缩压≥140 mm Hg和/或舒张压≥90 mm Hg者,则诊断高血压;如既往诊断高血压,目前服用药物情况下血压处于参考范围,也诊断为高血压[ | 二分类变量:是/否 |
糖尿病 | 空腹血糖水平≥7 mmol/L,或有医生诊断的糖尿病史,或服用降糖药物[ | 二分类变量:是/否 |
心房颤动 | 诊断依据:存在心房颤动病史,或常规心电图提示心房颤动,或动态心电图提示心房颤动[ | 二分类变量:是/否 |
MWT | 超声心动图测定的MWT | 连续性变量:mm |
LA内径 | 超声心动图测定的LA前后径 | 连续性变量:mm |
LVOTO | 左心室流出道静息压力阶差≥30 mm Hg[ | 二分类变量:是/否 |
NYHA心功能分级 | Ⅰ级:有心脏病但体力活动不受限制;日常体力活动不引起明显的疲乏、心悸、呼吸困难、心绞痛等症状 | 二分类变量:Ⅲ/Ⅳ级为是,Ⅰ/Ⅱ级为否 |
Ⅱ级:体力活动轻度受限;休息时无自觉症状,日常活动可出现较明显的上述症状,休息后很快缓解 | ||
Ⅲ级:体力活动明显受限;休息时可无症状,轻于日常活动即引起上述症状,休息较长时间后方可缓解 | ||
Ⅳ级:不能从事任何体力活动;休息时亦有心衰的症状,体力活动后明显加重 | ||
LVEF | 超声心动图测定的左心室射血分数 | 连续性变量:% |
变量 | 未发生TE事件(n=471) | 发生TE事件(n=42) | χ2(Z)值 | P值 |
---|---|---|---|---|
性别(男/女) | 267/204 | 16/26 | 4.664 | 0.031 |
年龄〔M(P25,P75),岁〕 | 57.0(44.0,66.0) | 66.0(51.3,73.0) | 12.027a | 0.001 |
既往TE事件〔n(%)〕 | 20(4.25) | 7(16.67) | — | 0.004 |
血管疾病〔n(%)〕 | 35(7.43) | 5(11.90) | — | 0.360 |
高血压〔n(%)〕 | 147(31.21) | 15(35.71) | 0.184 | 0.668 |
糖尿病〔n(%)〕 | 33(7.01) | 7(16.67) | — | 0.035 |
心房颤动〔n(%)〕 | 65(13.80) | 22(52.38) | 38.063 | <0.001 |
MWT〔M(P25,P75),mm〕 | 19.0(17.0,22.0) | 18.0(16.0,21.0) | 2.466a | 0.116 |
LA内径〔M(P25,P75),mm〕 | 40.0(35.0,45.0) | 43.0(38.2,46.0) | 6.955a | 0.008 |
LVOTO〔n(%)〕 | 208(44.16) | 14(33.33) | 1.427 | 0.232 |
NYHA心功能Ⅲ/Ⅳ级〔n(%)〕 | 163(34.61) | 13(30.95) | 0.095 | 0.758 |
LVEF〔M(P25,P75),%〕 | 69.0(63.0,73.0) | 67.5(62.2,70.0) | 3.712a | 0.054 |
阿司匹林〔n(%)〕 | 84(17.83) | 10(23.81) | 0.564 | 0.453 |
氯吡格雷〔n(%)〕 | 28(5.94) | 3(7.14) | — | 0.733 |
华法林〔n(%)〕 | 35(7.43) | 10(23.81) | — | 0.002 |
Table 2 Baseline characteristics in hypertrophic cardiomyopathy patients with and without thrombotic events
变量 | 未发生TE事件(n=471) | 发生TE事件(n=42) | χ2(Z)值 | P值 |
---|---|---|---|---|
性别(男/女) | 267/204 | 16/26 | 4.664 | 0.031 |
年龄〔M(P25,P75),岁〕 | 57.0(44.0,66.0) | 66.0(51.3,73.0) | 12.027a | 0.001 |
既往TE事件〔n(%)〕 | 20(4.25) | 7(16.67) | — | 0.004 |
血管疾病〔n(%)〕 | 35(7.43) | 5(11.90) | — | 0.360 |
高血压〔n(%)〕 | 147(31.21) | 15(35.71) | 0.184 | 0.668 |
糖尿病〔n(%)〕 | 33(7.01) | 7(16.67) | — | 0.035 |
心房颤动〔n(%)〕 | 65(13.80) | 22(52.38) | 38.063 | <0.001 |
MWT〔M(P25,P75),mm〕 | 19.0(17.0,22.0) | 18.0(16.0,21.0) | 2.466a | 0.116 |
LA内径〔M(P25,P75),mm〕 | 40.0(35.0,45.0) | 43.0(38.2,46.0) | 6.955a | 0.008 |
LVOTO〔n(%)〕 | 208(44.16) | 14(33.33) | 1.427 | 0.232 |
NYHA心功能Ⅲ/Ⅳ级〔n(%)〕 | 163(34.61) | 13(30.95) | 0.095 | 0.758 |
LVEF〔M(P25,P75),%〕 | 69.0(63.0,73.0) | 67.5(62.2,70.0) | 3.712a | 0.054 |
阿司匹林〔n(%)〕 | 84(17.83) | 10(23.81) | 0.564 | 0.453 |
氯吡格雷〔n(%)〕 | 28(5.94) | 3(7.14) | — | 0.733 |
华法林〔n(%)〕 | 35(7.43) | 10(23.81) | — | 0.002 |
变量 | 单因素Cox回归分析 | 多因素Cox回归分析 | ||||
---|---|---|---|---|---|---|
HR(95%CI) | P值 | β | HR(95%CI) | P值 | ||
性别(以男性为参照) | ||||||
女 | 1.85(0.99,3.45) | 0.053 | — | — | — | |
年龄(岁,以<50岁为参照) | ||||||
50~<70 | 1.69(0.73,3.92) | 0.221 | 0.329 | 1.39(0.59,3.28) | 0.452 | |
≥70 | 4.46(1.92,10.4) | <0.001 | 1.107 | 3.02(1.25,7.34) | 0.014 | |
既往TE事件 | 5.62(2.49,12.7) | <0.001 | 1.174 | 3.24(1.38,7.61) | 0.007 | |
血管疾病1 | .92(0.75,4.90) | 0.174 | — | — | — | |
高血压 | 1.30(0.69,2.44) | 0.420 | — | — | — | |
糖尿病 | 2.20(0.97,4.94) | 0.058 | — | — | — | |
心房颤动 | 5.95(3.24,10.90) | <0.001 | 1.472 | 4.36(2.31,8.23) | <0.001 | |
MWT(mm,以<20.0 mm为参照) | ||||||
20.0~<25.0 | 0.98(0.51,1.88) | 0.949 | — | — | — | |
25.0~<30.0 | 0.49(0.12,2.09) | 0.338 | — | — | — | |
≥30.0 | 0(0,Inf) | 0.996 | — | — | — | |
LA内径(mm,以<35.0 mm为参照) | ||||||
35.0~<40.0 | 1.52(0.47,4.95) | 0.484 | — | — | — | |
40.0~<45.0 | 3.14(1.03,9.55) | 0.044 | — | — | — | |
≥45.0 | 2.80(0.93,8.44) | 0.067 | — | — | — | |
LVOTO | 0.72(0.38,1.37) | 0.314 | — | — | — | |
NYHA心功能分级(以Ⅰ/Ⅱ级为参照) | ||||||
Ⅲ/Ⅳ级 | 1.05(0.54,2.02) | 0.887 | — | — | — | |
LVEF(%,以<50.0%为参照) | ||||||
50.0~<70.0 | 0.56(0.17,1.86) | 0.344 | -0.981 | 0.37(0.11,1.29) | 0.120 | |
≥70.0 | 0.31(0.09,1.08) | 0.067 | -1.407 | 0.24(0.07,0.91) | 0.035 | |
阿司匹林 | 1.35(0.67,2.76) | 0.402 | — | — | — | |
氯吡格雷 | 1.26(0.39,4.07) | 0.702 | — | — | — | |
华法林 | 4.33(2.11,8.89) | <0.001 | — | — | — |
Table 3 Univariate and multvariate Cox regression analyses for factors predicting the risk of thrombotic events in hypertrophic cardiomyopathy patients
变量 | 单因素Cox回归分析 | 多因素Cox回归分析 | ||||
---|---|---|---|---|---|---|
HR(95%CI) | P值 | β | HR(95%CI) | P值 | ||
性别(以男性为参照) | ||||||
女 | 1.85(0.99,3.45) | 0.053 | — | — | — | |
年龄(岁,以<50岁为参照) | ||||||
50~<70 | 1.69(0.73,3.92) | 0.221 | 0.329 | 1.39(0.59,3.28) | 0.452 | |
≥70 | 4.46(1.92,10.4) | <0.001 | 1.107 | 3.02(1.25,7.34) | 0.014 | |
既往TE事件 | 5.62(2.49,12.7) | <0.001 | 1.174 | 3.24(1.38,7.61) | 0.007 | |
血管疾病1 | .92(0.75,4.90) | 0.174 | — | — | — | |
高血压 | 1.30(0.69,2.44) | 0.420 | — | — | — | |
糖尿病 | 2.20(0.97,4.94) | 0.058 | — | — | — | |
心房颤动 | 5.95(3.24,10.90) | <0.001 | 1.472 | 4.36(2.31,8.23) | <0.001 | |
MWT(mm,以<20.0 mm为参照) | ||||||
20.0~<25.0 | 0.98(0.51,1.88) | 0.949 | — | — | — | |
25.0~<30.0 | 0.49(0.12,2.09) | 0.338 | — | — | — | |
≥30.0 | 0(0,Inf) | 0.996 | — | — | — | |
LA内径(mm,以<35.0 mm为参照) | ||||||
35.0~<40.0 | 1.52(0.47,4.95) | 0.484 | — | — | — | |
40.0~<45.0 | 3.14(1.03,9.55) | 0.044 | — | — | — | |
≥45.0 | 2.80(0.93,8.44) | 0.067 | — | — | — | |
LVOTO | 0.72(0.38,1.37) | 0.314 | — | — | — | |
NYHA心功能分级(以Ⅰ/Ⅱ级为参照) | ||||||
Ⅲ/Ⅳ级 | 1.05(0.54,2.02) | 0.887 | — | — | — | |
LVEF(%,以<50.0%为参照) | ||||||
50.0~<70.0 | 0.56(0.17,1.86) | 0.344 | -0.981 | 0.37(0.11,1.29) | 0.120 | |
≥70.0 | 0.31(0.09,1.08) | 0.067 | -1.407 | 0.24(0.07,0.91) | 0.035 | |
阿司匹林 | 1.35(0.67,2.76) | 0.402 | — | — | — | |
氯吡格雷 | 1.26(0.39,4.07) | 0.702 | — | — | — | |
华法林 | 4.33(2.11,8.89) | <0.001 | — | — | — |
Figure 5 Calibration plots for predicted versus observed 1-,3-,5-year risk of thrombotic events for hypertrophic cardiomyopathy patients with atrial fibrillation
Figure 6 Predictive power of SAAE score for 1-,3- and 5-year risk of thrombotic events for hypertrophic cardiomyopathy patients without atrial fibrillation
Figure 7 Calibration plots for predicted versus observed 1-,3-,5-year risk of thrombotic events for hypertrophic cardiomyopathy patients without atrial fibrillation
分类 | 低风险 | 中风险 | 高风险 |
---|---|---|---|
整体人群 | <7.56 | 7.56~<17.38 | ≥17.38 |
心房颤动人群 | <17.56 | 17.56~<21.42 | ≥21.42 |
非心房颤动人群 | <3.87 | 3.87~<11.25 | ≥11.25 |
Table 4 Cutoff points of SAAE score for low,moderate and high risk of thrombotic events in different populations
分类 | 低风险 | 中风险 | 高风险 |
---|---|---|---|
整体人群 | <7.56 | 7.56~<17.38 | ≥17.38 |
心房颤动人群 | <17.56 | 17.56~<21.42 | ≥21.42 |
非心房颤动人群 | <3.87 | 3.87~<11.25 | ≥11.25 |
Figure 8 Kaplan-Meier analysis showing cumulative thrombotic events in hypertrophic cardiomyopathy patients with low,moderate or high thrombotic risk predicted by SAAE score
人群 | 评分模型 | 整体 | 1年 | 3年 | 5年 | ||||
---|---|---|---|---|---|---|---|---|---|
Harrell's C-指数 | P值 | Harrell's C-指数 | P值 | Harrell's C-指数 | P值 | Harrell's C-指数 | P值 | ||
整体人群 | SAAE score | 0.757 | 0.013 | 0.790 | 0.413 | 0.799 | 0.137 | 0.735 | 0.117 |
HCM Risk-CVA | 0.671 | 0.710 | 0.715 | 0.670 | |||||
心房颤动人群 | SAAE score | 0.670 | 0.110 | 0.745 | 0.112 | 0.671 | 0.162 | 0.616 | 0.738 |
HCM Risk-CVA | 0.560 | 0.557 | 0.538 | 0.587 | |||||
非心房颤动人群 | SAAE score | 0.624 | 0.549 | 0.661 | 0.828 | 0.697 | 0.899 | 0.634 | 0.644 |
HCM Risk-CVA | 0.592 | 0.696 | 0.710 | 0.603 |
Table 5 Comparisons between SAAE score and HCM Risk-CVA score for predicting the risk of thrombotic events in hypertrophic cardiomyopathy
人群 | 评分模型 | 整体 | 1年 | 3年 | 5年 | ||||
---|---|---|---|---|---|---|---|---|---|
Harrell's C-指数 | P值 | Harrell's C-指数 | P值 | Harrell's C-指数 | P值 | Harrell's C-指数 | P值 | ||
整体人群 | SAAE score | 0.757 | 0.013 | 0.790 | 0.413 | 0.799 | 0.137 | 0.735 | 0.117 |
HCM Risk-CVA | 0.671 | 0.710 | 0.715 | 0.670 | |||||
心房颤动人群 | SAAE score | 0.670 | 0.110 | 0.745 | 0.112 | 0.671 | 0.162 | 0.616 | 0.738 |
HCM Risk-CVA | 0.560 | 0.557 | 0.538 | 0.587 | |||||
非心房颤动人群 | SAAE score | 0.624 | 0.549 | 0.661 | 0.828 | 0.697 | 0.899 | 0.634 | 0.644 |
HCM Risk-CVA | 0.592 | 0.696 | 0.710 | 0.603 |
Figure 9 Decision curve analysis of SAAE score and HCM Risk-CVA score for predicting the risk of thrombotic events in hypertrophic cardiomyopathy at different time points
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