Multimodal Data‐Driven Prognostic Model for Predicting Long‐Term Prognosis in Patients With Ischemic Cardiomyopathy and Heart Failure With Preserved Ejection Fraction After Coronary Artery Bypass Grafting: A Multicenter Cohort Study

医学 内科学 射血分数 心力衰竭 心脏病学 列线图 心肌梗塞 队列 缺血性心肌病
作者
Jun Wang,Yijun Wang,Shoupeng Duan,Li Xu,Yanan Xu,Wenyuan Yin,Yi Yang,Bing Wu,J Liu
出处
期刊:Journal of the American Heart Association [Ovid Technologies (Wolters Kluwer)]
标识
DOI:10.1161/jaha.124.036970
摘要

Background Limited data from the literature are available to assess the efficacy of coronary artery bypass grafting in patients with ischemic cardiomyopathy and heart failure with preserved ejection fraction. Therefore, our objective was to use machine learning techniques integrating clinical features, biomarker data, and echocardiography data to enhance comprehension and risk stratification in patients diagnosed with ischemic cardiomyopathy and heart failure with preserved ejection fraction who have undergone coronary artery bypass grafting surgery. Methods and Results For this study, 294 patients with ischemic cardiomyopathy and heart failure with preserved ejection fraction who underwent coronary artery bypass grafting surgery were assigned to the development cohort (n=176) and the independent validation cohort (n=118). A total of 52 clinical variables were extracted for each patient. The principal clinical end point was the incidence of major adverse cardiovascular events, encompassing cardiac mortality, acute myocardial infarction, acute heart failure, and graft failure. From least absolute shrinkage and selection operator regression, 4 predictors were selected for the final prediction nomogram: diabetes, hypertension, the systemic immune‐inflammation index, and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide). The prediction nomogram achieved satisfactory prediction performance in both the development cohort (C index, 0.768 [95% CI, 0.701–0.835]) and independent validation cohort (C index, 0.633 [95% CI, 0.521–0.745]). Adequate calibration was noted for the likelihood of major adverse cardiovascular events in both the development and independent validation cohorts. Decision curve analysis confirmed the clinical usefulness of the established prediction nomogram. Conclusions A clinically feasible prognostic model, based on preoperative multimodal data, was developed for risk stratification of patients with ischemic heart and heart failure with preserved ejection fraction who receive coronary artery bypass grafting surgery. Registration https://www.chictr.org.cn ; Unique identifier: ChiCTR2300074439.
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