美国马萨诸塞州总医院Patrick T. Ellinor团队开发并验证了无症状患者升主动脉直径预测模型。相关论文发表在2022年11月15日出版的《美国医学会杂志》上。

胸廓升主动脉疾病是美国猝死的重要原因，但大多数主动脉瘤都是偶然发现的。

为了建立并验证评估升主动脉直径的临床评分，研究组使用英国生物银行队列研究的一项正在进行的磁共振成像亚研究，该研究从2006-2010年招募参与者，对30018名参与者进行了评分推导，另有6681人进行了内部验证。

2002-2005年，弗雷明翰心脏研究（FHS）子代队列中接受计算机断层扫描的1367名参与者，以及社区护理队列项目（MGB，2001-2018年马萨诸塞州布里格姆市网络纵向初级护理患者的回顾性医院队列）中接受经胸超声心动图检查的50768名患者进行了外部验证。

暴露因素为人口统计学和临床变量（11个协变量，不会独立提示胸部成像）。升主动脉直径采用分层组最小绝对收缩和选择算子（LASSO）回归建模。评估了估计直径和测量直径之间的相关性以及识别直径4.0 cm或更大的性能。

30018名参与者（52%为女性）的平均年龄为65.1岁。女性升主动脉平均直径（SD）为3.04（0.31）cm，男性为3.32（0.34）cm。评估升主动脉直径的评分解释了英国生物银行验证队列中28.2%的主动脉直径差异、FHS队列中30.8%的差异和MGB队列中32.6%的差异。

对于检测升主动脉直径为4cm或更大的个体，英国生物银行的受试者-操作者特征曲线下的面积为0.770，FHS为0.813，MGB队列为0.766，尽管模型在外部验证中显著高估或低估了主动脉直径。

使用3.537的固定评分阈值，英国生物银行每9.7人、FHS每1.8人和MGB每4.6人需要成像来确认1名升主动脉直径为4cm或更大的患者。英国生物银行、FHS和MGB队列在该阈值的敏感性分别为8.9%、11.3%和18.8%，特异性分别为98.1%、99.2%和96.2%。

研究结果表明，基于常见的临床可用数据导出并验证预测模型，可预测升主动脉直径。仍需要进一步研究来优化预测模型，并确定其使用是否与改善预后相关。

附：英文原文

Title: Development of a Prediction Model for Ascending Aortic Diameter Among Asymptomatic Individuals

Author: James P. Pirruccello, Honghuang Lin, Shaan Khurshid, Mahan Nekoui, Lu-Chen Weng, Vasan S. Ramachandran, Eric M. Isselbacher, Emelia J. Benjamin, Steven A. Lubitz, Mark E. Lindsay, Patrick T. Ellinor

Issue&Volume: 2022/11/15

Abstract:

Importance  Ascending thoracic aortic disease is an important cause of sudden death in the US, yet most aortic aneurysms are identified incidentally.

Objective  To develop and validate a clinical score to estimate ascending aortic diameter.

Design, Setting, and Participants  Using an ongoing magnetic resonance imaging substudy of the UK Biobank cohort study, which had enrolled participants from 2006 through 2010, score derivation was performed in 30018 participants and internal validation in an additional 6681. External validation was performed in 1367 participants from the Framingham Heart Study (FHS) offspring cohort who had undergone computed tomography from 2002 through 2005, and in 50768 individuals who had undergone transthoracic echocardiography in the Community Care Cohort Project, a retrospective hospital-based cohort of longitudinal primary care patients in the Mass General Brigham (MGB) network between 2001-2018.

Exposures  Demographic and clinical variables (11 covariates that would not independently prompt thoracic imaging).

Main Outcomes and Measures  Ascending aortic diameter was modeled with hierarchical group least absolute shrinkage and selection operator (LASSO) regression. Correlation between estimated and measured diameter and performance for identifying diameter 4.0 cm or greater were assessed.

Results  The 30018-participant training cohort (52% women), were a median age of 65.1 years (IQR, 58.6-70.6 years). The mean (SD) ascending aortic diameter was 3.04 (0.31) cm for women and 3.32 (0.34) cm for men. A score to estimate ascending aortic diameter explained 28.2% of the variance in aortic diameter in the UK Biobank validation cohort (95% CI, 26.4%-30.0%), 30.8% in the FHS cohort (95% CI, 26.8%-34.9%), and 32.6% in the MGB cohort (95% CI, 31.9%-33.2%). For detecting individuals with an ascending aortic diameter of 4 cm or greater, the score had an area under the receiver operator characteristic curve of 0.770 (95% CI, 0.737-0.803) in the UK Biobank, 0.813 (95% CI, 0.772-0.854) in the FHS, and 0.766 (95% CI, 0.757-0.774) in the MGB cohorts, although the model significantly overestimated or underestimated aortic diameter in external validation. Using a fixed-score threshold of 3.537, 9.7 people in UK Biobank, 1.8 in the FHS, and 4.6 in the MGB cohorts would need imaging to confirm 1 individual with an ascending aortic diameter of 4 cm or greater. The sensitivity at that threshold was 8.9% in the UK Biobank, 11.3% in the FHS, and 18.8% in the MGB cohorts, with specificities of 98.1%, 99.2%, and 96.2%, respectively.

Conclusions and Relevance  A prediction model based on common clinically available data was derived and validated to predict ascending aortic diameter. Further research is needed to optimize the prediction model and to determine whether its use is associated with improved outcomes.

DOI: 10.1001/jama.2022.19701

Source: https://jamanetwork.com/journals/jama/article-abstract/2798406