Development and validation of a score predicting mortality for older patients with mitral regurgitation
China-DVD and China-VHD study investigators
Department of Cardiology,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Sci-ence and Peking Union Medical College,Beijing,China
摘要：OBJECTIVE To develop and validate a user-friendly risk score for older mitral regurgitation(MR)patients,referred to as the Elder-MR score.METHODS The China Senile Valvular Heart Disease(China-DVD)Cohort Study functioned as the development cohort,while the China Valvular Heart Disease(China-VHD)Study was employed for external validation.We included patients aged 60 years and above receiving medical treatment for moderate or severe MR(2274 patients in the development cohort and 1929 patients in the val-idation cohort).Candidate predictors were chosen using Cox's proportional hazards model and stepwise selection with Akaike's information criterion.RESULTS Eight predictors were identified:age≥75 years,body mass index<20 kg/m2,NYHA class Ⅲ/Ⅳ,secondary MR,ane-mia,estimated glomerular filtration rate<60 mL/min per 1.73 m2,albumin<35 g/L,and left ventricular ejection fraction<60％.The model displayed satisfactory performance in predicting one-year mortality in both the development cohort(C-statistic = 0.73,95％CI:0.69-0.77,Brier score = 0.06)and the validation cohort(C-statistic = 0.73,95％CI:0.68-0.78,Brier score = 0.06).The Elder-MR score ranges from 0 to 15 points.At a one-year follow-up,each point increase in the Elder-MR score represents a 1.27-fold risk of death(HR = 1.27,95％CI:1.21-1.34,P<0.001)in the development cohort and a 1.24-fold risk of death(HR = 1.24,95％CI:1.17-1.30,P<0.001)in the validation cohort.Compared to EuroSCORE II,the Elder-MR score demonstrated superior predictive accuracy for one-year mortality in the validation cohort(C-statistic = 0.71 vs.0.70,net reclassification improvement = 0.320,P<0.01;integrated dis-crimination improvement = 0.029,P<0.01).CONCLUSIONS The Elder-MR score may serve as an effective risk stratification tool to assist clinical decision-making in older MR patients.
机标关键词：developmentscorewithmitralmortalityolderpatientspredicting
论文发表日期：2023-08-28
在线出版日期：2025-08-15（本平台首次上网日期，不代表文献的发表时间）
页数：9( 577-585 )