Development and validation of a score predicting mortality for older patients with mitral regurgitation

作     者：De-Jing FENG Yun-Qing YE Zhe LI Bin ZHANG Qing-Rong LIU Wei-Wei WANG Zhen-Yan ZHAO Zheng ZHOU Qing-Hao ZHAO Zi-Kai YU Hai-Tong ZHANG Zhen-Ya DUAN Bin-Cheng WANG Jun-Xing LV Shuai GUO Run-Lin GAO Hai-Yan XU Yong-Jian WU on behalf of the China-DVD and China-VHD study investigators 

作者机构：Department of CardiologyFuwai HospitalNational Center for Cardiovascular DiseaseChinese Academy of Medical Science and Peking Union Medical CollegeBeijingChina 

出 版 物：《老年心脏病学杂志:英文版》 (Journal of Geriatric Cardiology)

年 卷 期：2023年第20卷第8期

页      面：577-585页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：supported by the National Key R&D Program of China(No.2020YFC2008100) 

主　　题：patients mitral score 

摘      要：OBJECTIVE To develop and validate a user-friendly risk score for older mitral regurgitation(MR)patients,referred to as the Elder-MR *** 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 *** 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 validation cohort).Candidate predictors were chosen using Cox’s proportional hazards model and stepwise selection with Akaike’s information *** Eight predictors were identified:age≥75 years,body mass index20 kg/m^(2),NYHA class Ⅲ/Ⅳ,secondary MR,anemia,estimated glomerular filtration rate60 mL/min per 1.73 m^(2),albumin35 g/L,and left ventricular ejection fraction60%.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 *** 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,P0.001)in the development cohort and a 1.24-fold risk of death(HR=1.24,95%CI:1.17-1.30,P0.001)in the validation *** 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,P0.01;integrated discrimination improvement=0.029,P0.01).CONCLUSIONS The Elder-MR score may serve as an effective risk stratification tool to assist clinical decision-making in older MR patients.