Construction and validation of risk prediction model for serious adverse events in adult patients with congenital heart disease complicated with pulmonary hypertension after cardiac catheterization_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HU Juanzhou ¹ ,  ZHANG Yinghong ¹ , ZHANG Wen ² , HUANG Jing ³ , LIU Jia ¹ , PENG Pan ¹

1. Medical College, Wuhan University of Science and Technology, Wuhan, 430065, P. R. China;
2. Department of Cardiovascular Surgery, Wuhan Asian Heart Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, 430065, P. R. China;
3. Department of Cardiovascular Surgery, Wuhan Puren Hospital, Wuhan, 430065, P. R. China;

Corresponding author：

ZHANG Yinghong, Email: Zhangyinghong@wust.edu.cn

Keywords：

Adult congenital heart disease; pulmonary hypertension; catheterization; serious adverse event; risk prediction model

DOI：

10.7507/1007-4848.202209045

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Objective To construct a risk prediction score model for serious adverse event (SAE) after cardiac catheterization in patients with adult congenital heart disease (ACHD) and pulmonary hypertension (PH) and verify its predictive effect. Methods The patients with PH who underwent cardiac catheterization in Wuhan Asian Heart Hospital Affiliated to Wuhan University of Science and Technology from January 2018 to January 2022 were retrospectively collected. The patients were randomly divided into a model group and a validation group according to the order of admission. The model group was divided into a SAE group and a non-SAE group according to whether SAE occurred after the catheterization. The data of the two groups were compared, and the risk prediction score model was established according to the results of multivariate logistic regression analysis. The discrimination and calibration of the model were evaluated using the area under the receiver operating characteristic (ROC) curve and the Hosmer-Lemeshow test, respectively. Results A total of 758 patients were enrolled, including 240 (31.7%) males and 518 (68.3%) females, with a mean age of 43.1 (18.0-81.0) years. There were 530 patients in the model group (47 patients in the SAE group and 483 patients in the non-SAE group) and 228 patients in the validation group. Univariate analysis showed statistical differences in age, smoking history, valvular disease history, heart failure history, N-terminal pro-B-type natriuretic peptide, and other factors between the SAE and non-SAE groups (P<0.05). Multivariate analysis showed that age≥50 years, history of heart failure, moderate to severe congenital heart disease, moderate to severe PH, cardiac catheterization and treatment, surgical general anesthesia, and N-terminal pro-B-type natriuretic peptide≥126.65 pg/mL were risk factors for SAE after cardiac catheterization for ACHD-PH patients (P<0.05). The risk prediction score model had a total score of 0-139 points and patients who had a score>50 points were high-risk patients. Model validation results showed an area under the ROC curve of 0.937 (95%CI 0.897-0.976). Hosmer-Lemeshow goodness-of-fit test: χ²=3.847, P=0.797. Conclusion Age≥50 years, history of heart failure, moderate to severe congenital heart disease, moderate to severe PH, cardiac catheterization and treatment, general anesthesia for surgery, and N-terminal pro-B-type natriuretic peptide≥126.65 pg/mL were risk factors for SAE after cardiac catheterization for ACHD-PH patients. The risk prediction model based on these factors has a high predictive value and can be applied to the risk assessment of SAE after interventional therapy in ACHD-PH patients to help clinicians perform early intervention.

Citation： HU Juanzhou, ZHANG Yinghong, ZHANG Wen, HUANG Jing, LIU Jia, PENG Pan. Construction and validation of risk prediction model for serious adverse events in adult patients with congenital heart disease complicated with pulmonary hypertension after cardiac catheterization. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(5): 768-775. doi: 10.7507/1007-4848.202209045 Copy

1.	Walpert AS, Thomas ID, Lowe MC, et al. RSV prophylaxis guideline changes and outcomes in children with congenital heart disease. Congenit Heart Dis, 2018, 13(3): 428-431.
2.	Kaemmerer AS, Gorenflo M, Huscher D, et al. Medical treatment of pulmonary hypertension in adults with congenital heart disease: Updated and extended results from the International COMPERA-CHD Registry. Cardiovasc Diagn Ther, 2021, 11(6): 1255-1268.
3.	D'Alto M, Mahadevan VS. Pulmonary arterial hypertension associated with congenital heart disease. Eur Respir Rev, 2012, 21(126): 328-337.
4.	中国医师学会心血管内科医师分会. 2015年先天性心脏病相关性肺动脉高压诊治中国专家共识. 中国介入心脏病学杂志, 2015, 23(2): 61-69.
5.	张小飞, 肖明第, 肖亦敏, 等. 成人重度肺动脉高压合并先天性心脏病. 中华胸心血管外科杂志, 2017, 33(4): 235-237.
6.	Akseer S, Abrahamyan L, Lee DS, et al. Long-term outcomes in adult patients with pulmonary hypertension after percutaneous closure of atrial septal defects. Circ Cardiovasc Interv, 2022, 15(1): e011110.
7.	Baumgartner H, De Backer J, Babu-Narayan SV, et al. 2020 ESC guidelines for the management of adult congenital heart disease. Eur Heart J, 2021, 42(6): 563-645.
8.	Jayaram N, Beekman RH, Benson L, et al. Adjusting for risk associated with pediatric and congenital cardiac catheterization: A report from the NCDR IMPACT Registry. Circulation, 2015, 132(20): 1863-1870.
9.	Bergersen L, Gauvreau K, Marshall A, et al. Procedure-type risk categories for pediatric and congenital cardiac catheterization. Circ Cardiovasc Interv, 2011, 4(2): 188-194.
10.	Taggart NW, Du W, Forbes TJ, et al. A model for assessment of catheterization risk in adults with congenital heart disease. Am J Cardiol, 2019, 123(9): 1527-1531.
11.	Wang YP, Zheng MY, Xiao YY, et al. Risk factors for necrotizing enterocolitis and establishment of prediction model of necrotizing enterocolitis in preterm infants. Zhongguo Dang Dai Er Ke Za Zhi, 2022, 24(1): 41-48.
12.	Woodward M, Tunstall-Pedoe H, Peters SA. Graphics and statistics for cardiology: Clinical prediction rules. Heart, 2017, 103(7): 538-545.
13.	林艳雅, 马飞, 叶根, 等. 急性A型主动脉夹层破裂风险预测模型的构建. 中华急诊医学杂志, 2019, 28(6): 729-735.
14.	Maurer SJ, Stöckemann K, Pujol C, et al. Pulmonary arterial hypertension associated with congenital heart disease in adults over the age of 40 years. J Clin Med, 2020, 9(12): 4071.
15.	Moons P, Luyckx K, Thomet C, et al. Patient-reported outcomes in the aging population of adults with congenital heart disease: Results from APPROACH-IS. Eur J Cardiovasc Nurs, 2022: zvac057.
16.	王建铭, 王琦光, 朱鲜阳. 《2020年欧洲心脏病学会成人先天性心脏病管理指南》解读. 中国介入心脏病学杂志, 2020, 28(9): 489-492.
17.	Brida M, Gatzoulis MA. Pulmonary arterial hypertension in adult congenital heart disease. Heart, 2018, 104(19): 1568-1574.
18.	Leczycki P, Banach M, Maciejewski M, et al. Heart failure risk predictions and prognostic factors in adults with congenital heart diseases. Front Cardiovasc Med, 2022, 9: 692815.
19.	Baggen VJ, van den Bosch AE, Eindhoven JA, et al. Prognostic value of N-terminal pro-B-type natriuretic peptide, troponin-T, and growth-differentiation factor 15 in adult congenital heart disease. Circulation, 2017, 135(3): 264-279.
20.	Gessler P, Knirsch W, Schmitt B, et al. Prognostic value of plasma N-terminal pro-brain natriuretic peptide in children with congenital heart defects and open-heart surgery. J Pediatr, 2006, 148(3): 372-376.
21.	Popelová JR, Kotaška K, Tomková M, et al. Usefulness of N-terminal pro-brain natriuretic peptide to predict mortality in adults with congenital heart disease. Am J Cardiol, 2015, 116(9): 1425-1430.
22.	Baggen VJM, Baart SJ, van den Bosch AE, et al. Prognostic value of serial N-terminal pro-B-type natriuretic peptide measurements in adults with congenital heart disease. J Am Heart Assoc, 2018, 7(7): e008349.
23.	郭月. 特发性肺动脉高压病人心导管检查围术期护理. 护理研究, 2016, 30(18): 2299-2300.
24.	Xu Z, Gatzoulis MA, Dimopoulos K, et al. Better outcomes in pulmonary arterial hypertension after repair of congenital heart disease, compared with idiopathic pulmonary arterial hypertension. CJC Open, 2021, 3(7): 872-879.

1. Walpert AS, Thomas ID, Lowe MC, et al. RSV prophylaxis guideline changes and outcomes in children with congenital heart disease. Congenit Heart Dis, 2018, 13(3): 428-431.
2. Kaemmerer AS, Gorenflo M, Huscher D, et al. Medical treatment of pulmonary hypertension in adults with congenital heart disease: Updated and extended results from the International COMPERA-CHD Registry. Cardiovasc Diagn Ther, 2021, 11(6): 1255-1268.
3. D'Alto M, Mahadevan VS. Pulmonary arterial hypertension associated with congenital heart disease. Eur Respir Rev, 2012, 21(126): 328-337.
4. 中国医师学会心血管内科医师分会. 2015年先天性心脏病相关性肺动脉高压诊治中国专家共识. 中国介入心脏病学杂志, 2015, 23(2): 61-69.
5. 张小飞, 肖明第, 肖亦敏, 等. 成人重度肺动脉高压合并先天性心脏病. 中华胸心血管外科杂志, 2017, 33(4): 235-237.
6. Akseer S, Abrahamyan L, Lee DS, et al. Long-term outcomes in adult patients with pulmonary hypertension after percutaneous closure of atrial septal defects. Circ Cardiovasc Interv, 2022, 15(1): e011110.
7. Baumgartner H, De Backer J, Babu-Narayan SV, et al. 2020 ESC guidelines for the management of adult congenital heart disease. Eur Heart J, 2021, 42(6): 563-645.
8. Jayaram N, Beekman RH, Benson L, et al. Adjusting for risk associated with pediatric and congenital cardiac catheterization: A report from the NCDR IMPACT Registry. Circulation, 2015, 132(20): 1863-1870.
9. Bergersen L, Gauvreau K, Marshall A, et al. Procedure-type risk categories for pediatric and congenital cardiac catheterization. Circ Cardiovasc Interv, 2011, 4(2): 188-194.
10. Taggart NW, Du W, Forbes TJ, et al. A model for assessment of catheterization risk in adults with congenital heart disease. Am J Cardiol, 2019, 123(9): 1527-1531.
11. Wang YP, Zheng MY, Xiao YY, et al. Risk factors for necrotizing enterocolitis and establishment of prediction model of necrotizing enterocolitis in preterm infants. Zhongguo Dang Dai Er Ke Za Zhi, 2022, 24(1): 41-48.
12. Woodward M, Tunstall-Pedoe H, Peters SA. Graphics and statistics for cardiology: Clinical prediction rules. Heart, 2017, 103(7): 538-545.
13. 林艳雅, 马飞, 叶根, 等. 急性A型主动脉夹层破裂风险预测模型的构建. 中华急诊医学杂志, 2019, 28(6): 729-735.
14. Maurer SJ, Stöckemann K, Pujol C, et al. Pulmonary arterial hypertension associated with congenital heart disease in adults over the age of 40 years. J Clin Med, 2020, 9(12): 4071.
15. Moons P, Luyckx K, Thomet C, et al. Patient-reported outcomes in the aging population of adults with congenital heart disease: Results from APPROACH-IS. Eur J Cardiovasc Nurs, 2022: zvac057.
16. 王建铭, 王琦光, 朱鲜阳. 《2020年欧洲心脏病学会成人先天性心脏病管理指南》解读. 中国介入心脏病学杂志, 2020, 28(9): 489-492.
17. Brida M, Gatzoulis MA. Pulmonary arterial hypertension in adult congenital heart disease. Heart, 2018, 104(19): 1568-1574.
18. Leczycki P, Banach M, Maciejewski M, et al. Heart failure risk predictions and prognostic factors in adults with congenital heart diseases. Front Cardiovasc Med, 2022, 9: 692815.
19. Baggen VJ, van den Bosch AE, Eindhoven JA, et al. Prognostic value of N-terminal pro-B-type natriuretic peptide, troponin-T, and growth-differentiation factor 15 in adult congenital heart disease. Circulation, 2017, 135(3): 264-279.
20. Gessler P, Knirsch W, Schmitt B, et al. Prognostic value of plasma N-terminal pro-brain natriuretic peptide in children with congenital heart defects and open-heart surgery. J Pediatr, 2006, 148(3): 372-376.
21. Popelová JR, Kotaška K, Tomková M, et al. Usefulness of N-terminal pro-brain natriuretic peptide to predict mortality in adults with congenital heart disease. Am J Cardiol, 2015, 116(9): 1425-1430.
22. Baggen VJM, Baart SJ, van den Bosch AE, et al. Prognostic value of serial N-terminal pro-B-type natriuretic peptide measurements in adults with congenital heart disease. J Am Heart Assoc, 2018, 7(7): e008349.
23. 郭月. 特发性肺动脉高压病人心导管检查围术期护理. 护理研究, 2016, 30(18): 2299-2300.
24. Xu Z, Gatzoulis MA, Dimopoulos K, et al. Better outcomes in pulmonary arterial hypertension after repair of congenital heart disease, compared with idiopathic pulmonary arterial hypertension. CJC Open, 2021, 3(7): 872-879.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Construction and validation of risk prediction model for serious adverse events in adult patients with congenital heart disease complicated with pulmonary hypertension after cardiac catheterization

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