Risk factors of severe ventricular arrhythmia after heart valve replacement and establishment of its risk nomogram model
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摘要: 目的:探究心脏瓣膜置换术后并发严重室性心律失常的独立危险因素,同时建立预测心脏瓣膜置换术后发生严重室性心律失常风险的列线图模型。方法:回顾性分析2016年12月-2018年12月在华西医院心脏大血管外科行心脏瓣膜置换术患者275例,通过单因素及多因素Logistic回归分析得到心脏瓣膜置换术后并发严重室性心律失常的独立危险因素,最终应用R语言建立预测术后发生严重室性心律失常风险的列线图模型并对该模型进行验证。结果:由多因素Logistic回归分析结果可知,病程(OR=3.040,95%CI:1.249~7.403)、左室射血分数(LVEF)(OR=2.953,95%CI:1.135~3.363)、重度三尖瓣关闭不全(OR=2.171,95%CI:1.194~3.946)、主动脉断流时间(OR=2.494,95%CI:1.025~2.923)、体外循环时间(OR=1.754,95%CI:(1.010~3.046)以及术后血流动力学紊乱(OR=2.488,95%CI:1.230~5.031)为心脏瓣膜置换术后并发严重室性心律失常的独立危险因素;基于上述危险因素成功建立列线图模型。验证后发现预测值同实测值基本一致,提示预测模型预测能力良好;随后采用Bootstrap内部验证法对预测模型进行验证,C-index为0.781(95%CI:0.725~0.836),说明该列线图预测模型预测效能高。结论:病程≥10年、LVEF<40%、重度三尖瓣关闭不全、主动脉断流时间>90 min、体外循环时间>120 min以及术后血流动力学紊乱是心脏瓣膜置换术后并发严重室性心律失常的独立危险因素,基于上述危险因素建立的列线图模型具有良好预测效能,有重要临床价值。Abstract: Objective: To investigate the independent risk factors of severe ventricular arrhythmia after heart valve replacement and to establish a nomogram model for predicting the risk of severe ventricular arrhythmia after heart valve replacement.Method: A retrospective analysis of 275 patients undergoing cardiac valve replacement in the Department of Cardiac Vascular Surgery from Huaxi Hospital from December 2016 to December 2018 was enrolled.Univariate and multivariate logistic regression analysis was performed to obtain independent risk factors of severe ventricular arrhythmia after cardiac valve replacement.Independent risk factors were used to establish a nomogram model for predicting the risk of severe ventricular arrhythmia after surgery and to validate the model.Result: The results of multivariate logistic regression analysis showed that the disease duration (OR=3.040, 95%CI:1.249-7.403), LVEF (OR=2.953, 95%CI:1.135-3.363), severe tricuspid insufficiency (OR=2.171), 95%CI:1.194-3.946), aortic crossclamp time (OR=2.494, 95%CI:1.025-2.923), cardiopulmonary bypass time (OR=1.754, 95%CI:(1.010 -3.046) and hemodynamic disorder (OR=2.488, 95%CI:1.230-5.031) were independent risk factors for severe ventricular arrhythmia after heart valve replacement.The nomogram model was successfully established based on the above risk factors.It was consistent with the measured values, which indicates that the prediction model had good prediction ability.Then the Bootstrap internal verification method was used to verify the prediction model.The C-index is 0.781(95%CI:0.725-0.836), which indicating that the nomogram model performed well.Conclusion: The disease duration ≥ 10 years, LVEF<40%, severe tricuspid insufficiency, aortic crossclamp time over 90 minutes, cardiopulmonary bypass time over 120 minutes, and hemodynamic disorder are independent risk factors of serious ventricular arrhythmia after cardiac valve replacement.Nomogram model based on these risk factors has good predictive efficacy and important clinical value.
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Key words:
- heart valve replacement /
- ventricular arrhythmia /
- risk factors /
- nomogram model
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[1] 董柱, 曹一秋, 张本, 等.人工瓣膜置换术后感染的危险因素分析及预防策略[J].临床心血管病杂志, 2019, 35(4):300-305.
[2] 韩劲松, 阎德民, 安君, 等.大、小左心室瓣膜置换术后并发症的比较及防治[J].中国循环杂志, 2006, 21(1):55-57.
[3] 王寅, 张平, 董念国, 等.大左心室心脏瓣膜病心瓣膜置换术后疗效及危险因素分析[J].中国胸心血管外科临床杂志, 2014, 21(4):440-446.
[4] 张军龙, 屠伟峰, 邢怡安, 等.老年患者体能状况对手术后严重室性心律失常的影响[J].中华老年心脑血管病杂志, 2016, 18(10):1046-1048.
[5] 马春朋, 刘晓丽, 王庆胜, 等.急性胸痛缺血风险评分模型的建立和验证[J].中华心血管病杂志, 2018, 46(2):131-136.
[6] Ma W, Zhang W, Shi W, et al.Left ventricular diastolic function after aortic valve replacement for chronic aortic regurgitation[J].Ann Thoracic Surg, 2018, 106(1):24-29.
[7] Samiei N, Hakimi MR, Mirmesdagh Y, et al.Surgical outcomes of heart valves replacement:A study of tertiary specialied cardiac center[J].ARYA Atheroscler, 2014, 10(5):233-237.
[8] 钱军岭, 王东进.重症心脏瓣膜病术后室性心律失常发生的危险因素分析[J].江苏医药, 2015, (12):1417-1419.
[9] 张鑫.心脏瓣膜置换术后室性心律失常发生的独立危险因素[J].医学新知杂志, 2018, 28(1):25-27.
[10] 唐先成, 刘健, 黄击修, 等.成形环治疗三尖瓣关闭不全的疗效及复发因素分析[J].岭南心血管病杂志, 2019, 25(3):331-335.
[11] Zientara A, Genoni M, Graves K, et al.Tricuspid valve repair for the poor right ventricle:tricuspid valve repair in patients with mild-to-moderate tricuspid regurgitation undergoing mitral valve repair improves in-hospital outcome[J].Thorac Cardiovasc Surg, 2017, 65(8):612-616.
[12] 刘兴荣, 马国涛, 刘剑州, 等.停循环技术应用于升主动脉-胸降主动脉人工血管旁路移植治疗主动脉缩窄[J].中国胸心血管外科临床杂志, 2019, 26(6):611-614.
[13] Ghiasi R, Mohammadi M, Majidinia M, et al.The effects of mebudipine on myocardial arrhythmia induced by ischemia-reperfusion injury in isolated rat heart[J].Cell Mol Biol, 2016, 62(13):15-20.
[14] 薛小临, 舒娟, 刘腾先, 等.巴尼地平减少急性心肌缺血与再灌注心律失常的发生[J].中华高血压杂志, 2019, 27(4):356-361.
[15] 余涛, 蒋龙元, 何志捷, 等.心脏外科术后患者心律失常临床分析[J].岭南急诊医学杂志, 2005, 10(2):83-84.
[16] Yasar U, Babaoglu MO.Extracorporeal circulation systems in coronary artery bypass surgery can affect pharmacokinetics of drugs:may altered CYP-mediated liver function be a possible reason[J].Eur J Clin Pharmacol, 2018, 74(8):1095.
[17] 夏漫辉, 沈振亚, 郑琳, 等.体外循环心脏直视术后心律失常的分析[J].现代实用医学, 2005, 17(4):24-25, 33.
[18] 钱鹏, 石开虎, 陶辉, 等.外科重构手术对终末期心脏瓣膜病患者心肺功能的影响[J].安徽医学, 2018, 39(4):415-418.
[19] 刘建, 郝嘉, 陈林, 等.主动脉内球囊反搏在重症瓣膜病术后低心排量综合征中的应用[J].第三军医大学学报, 2014, 36(13):1421-1423.
[20] 黄志鹏, 莫之超, 周蒙滔.胰腺癌列线图模型的临床应用[J].中华肝胆外科杂志, 2017, 23(9):645-648.
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