兰州大学学报（医学版）2025，Vol.51Issue(2)：17-24,8.DOI:10.13885/j.issn.1000-2812.2025.02.003
主动脉瓣狭窄病变患者TAVI术后发生瓣周漏的预测模型构建及验证
Construction and validation of a prediction model of perivalvu-lar leakage in patients with aortic stenosis after TAVI operation
摘要
Abstract
Objective To analyze risk factors of moderate or more perivalvular leakage after percutaneous aor-tic valve replacement(TAVI)in patients with aortic stenosis,and construct the risk prediction model of moder-ate or more perivalvular leakage,and validate the constructed model.Methods Clinical data of 128 patients with aortic stenosis undergoing TAVI treatment were retrospectively collected.All subjects were divided into occurrence group and non-occurrence group according to whether moderate or above perivalvular leakage occurred after surgery.Clinical data of the two groups were collected.The risk factors of perivalvular leakage after TAVI in patients with aortic stenosis were analyzed by univariate and multivariate analysis.The selected risk factors were incorporated into R software to construct the risk diagram model of perivalvular leakage in patients with arterial stenosis after TAVI surgery,and the constructed model was verified.Results Of the 128 patients,13 had moderate perivalvular leakage and 7 had severe perivalvular leakage after TAVI.The risk of moderate or above perivalvular leakage was 15.63%.The male proportion of left ventricular end-diastolic diameter,left ventricular end-systolic diameter,valve ring diameter,valve ring calcification volume,aortic an-gulation,left ventricular outflow tract(LVOT)coverage index and valve implantation depth in the occurrence group were higher than those in the non-occurrence group(P>0.05),and the relative wall thickness(RWT)in the occurrence group was lower than that in the non-occurrence group(P<0.05).Logistic regression analysis showed that RWT(<0.48),annular calcification volume(≥596.45 mm3),aortic angulation(≥54.23°),LVOT coverage index(≥0.89),and valve implantation depth(≥10.12 mm)were risk factors for moderate or higher perivalvular leakage in patients with aortic stenosis(P<0.05).Receiver operating characteristics(ROC)curve results showed that the area under the curve of the nomogram risk model predicting moderate or more perivalvular leakage in patients with aortic stenosis after TAVI surgery was 0.871(95%CI:[0.657,0.996]),the sensitivity and specificity were 95.30%and 79.40%,respectively,indicating that the prediction efficiency of the model was good.The C index of the nomogram prediction model was 0.836(95%CI:[0.785,0.945]).The calibration curve showed that both the predicted and actual values were close to the ideal curve,and the Hosmer-Lemeshow goodness of fit curve test χ2=2.987,P=0.637.The decision curve showed that when the high risk threshold was[0,0.7],the net return was>0,which had good clinical practicability.The net return increased as the risk threshold decreased,and the maximum net return was 0.184.Conclusion In this study,the risk nomogram model constructed by integrating 5 risk factors has high predictive value for the occurrence of moderate or above perivalvular leakage in patients with postoperative aortic stenosis,and has good calibra-tion degree,fit curvature and clinical practicability.关键词
主动脉瓣狭窄病变/经皮主动脉瓣置换术/瓣周漏/列线图模型/预测模型/危险因素Key words
aortic valve stenosis/percutaneous aortic valve replacement/perivalvular leakage/nomogram model/predictive model/risk factor分类
临床医学引用本文复制引用
沈剑虹,杨向东,牛伟,双链..主动脉瓣狭窄病变患者TAVI术后发生瓣周漏的预测模型构建及验证[J].兰州大学学报（医学版）,2025,51(2):17-24,8.基金项目
内蒙古医科大学面上科研项目(YKD2022MS077) （YKD2022MS077）
