摘要
Abstract
Objective To explore the factors affecting the tolerance of heart failure with reduced ejection fraction(HFrEF)patients to sacubitril/valsartan(SV),construct a nomogram model,and assess its predictive value.Methods A total of 150 HFrEF patients admitted to the cardiovascular department of Wenzhou TCM Hospital of Zhejiang Chinese Medical University from January 2020 to December 2022 were included.Clinical and laboratory data from all patients were collected.SV treatment was adopted.Patients were followed up for 3 months to observe whether reached the target dose of SV(200 mg,twice/day),and were divided into tolerance group(45 cases)and control group(105 cases)accordingly.Clinical data between two groups were compared.Multivariate Logistic regression analysis was used to identify factors affecting SV tolerance in patients.A nomogram model was established using R software,and calibration curve and receiver operating characteristic(ROC)curve were performed to evaluate the model's internal effecacy in predicting SV tolerance.Results Only 30.00%of patients reached the target dose.The age of the tolerance group was lower than that of the control group,and systolic blood pressure levels,proportion of combined right heart failure,body mass index(BMI),proportion of history of oral medium to high doses of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers(ACEI/ARB)in the tolerance group were higher than those of the control group,with statistically significant differences(P＜0.05).Multivariate Logistic regression analysis showed that age,BMI,combined right heart failure,and intake of medium to high doses of ACEI/ARB were influencing factors for SV tolerance(OR=0.833,1.379,3.167,2.720;P＜0.05).A nomogram model was constructed using these influencing factors,with a C-index of 0.927(95%CI=0.889-0.984).Calibration curve of the model closely matched the ideal model.ROC curve analysis showed that the area under the curve of predicting SV tolerance was 0.928,the sensitivity was 91.11%,and the specificity was 81.90%.Conclusion The construction of a nomogram model can assess SV tolerance of patients,providing guidance for clinical treatment.关键词
心力衰竭/沙库巴曲缬沙坦/耐受性/列线图模型Key words
Heart failure/Sacubitril/valsartan/Tolerance/Nomogram model
