Jennifer M Amadio, Martha Grogan, Eli Muchtar, Francisco Lopez-Jimenez, Zachi I Attia, Omar AbouEzzeddine, Grace Lin, Surendra Dasari, Suraj Kapa, Daniel D Borgeson, Paul A Friedman, Morie A Gertz, Dennis H Murphree, Angela Dispenzieri
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引用次数: 0
Abstract
Aims: We aim to determine if our previously validated, diagnostic artificial intelligence (AI) electrocardiogram (ECG) model is prognostic for survival among patients with cardiac amyloidosis (CA).
Methods: A total of 2533 patients with CA (1834 with light chain amyloidosis (AL), 530 with wild-type transthyretin amyloid protein (ATTRwt) and 169 with hereditary transthyretin amyloid (ATTRv)] were included. An amyloid AI ECG (A2E) score was calculated for each patient reflecting the likelihood of CA. CA stage was calculated using the European modification of the Mayo 2004 criteria for AL and Mayo stage for transthyretin amyloid (ATTR). Risk of death was modelled using Cox proportional hazards, and Kaplan-Meier was used to estimate survival.
Results: Median age of the cohort was 67 [inter-quartile ratio (IQR) 59, 74], and 71.6% were male. The median overall survival for the cohort was 35.6 months [95% confidence interval (CI) 32.3, 39.5]. For AL, ATTRwt and ATTRv, respectively, median survival was 22.9 (95% CI 19.2, 28.2), 47.2 (95% CI 43.4, 52.3) and 61.4 (95% CI 48.7, 75.9) months. On univariate analysis, an increasing A2E score was associated with more than a two-fold risk of all-cause death. On multivariable analysis, the A2E score retained its importance with a risk ratio of 2.0 (95% CI 1.58, 2.55) in the AL group and 2.7 (95% CI 1.81, 4.24) in the ATTR group.
Conclusions: Among patients with AL and ATTR amyloidosis, the A2E model helps to stratify risk of CA and adds another dimension of prognostication.
目的：我们旨在确定我们先前验证的人工智能（AI）心电图（ECG）诊断模型是否对心脏淀粉样变性（CA）患者的生存具有预后作用：共纳入2533名CA患者（1834名轻链淀粉样变性（AL）患者、530名野生型转甲状腺素淀粉样蛋白（ATTRwt）患者和169名遗传性转甲状腺素淀粉样蛋白（ATTRv）患者）。为每位患者计算淀粉样蛋白AI心电图（A2E）评分，以反映CA的可能性。CA分期采用梅奥2004年标准的欧洲修订版AL分期和转甲状腺素淀粉样蛋白（ATTR）的梅奥分期进行计算。死亡风险采用Cox比例危险模型，生存率采用Kaplan-Meier估计：组群的中位年龄为67岁[四分位数间比值（IQR）为59-74]，71.6%为男性。队列总生存期的中位数为 35.6 个月[95% 置信区间（CI）为 32.3 至 39.5]。AL、ATTRwt和ATTRv的中位生存期分别为22.9（95% CI 19.2，28.2）、47.2（95% CI 43.4，52.3）和61.4（95% CI 48.7，75.9）个月。在单变量分析中，A2E 评分的增加与全因死亡风险增加两倍以上有关。在多变量分析中，A2E评分仍具有重要意义，AL组的风险比为2.0（95% CI 1.58，2.55），ATTR组的风险比为2.7（95% CI 1.81，4.24）：在AL和ATTR淀粉样变性患者中，A2E模型有助于对CA的风险进行分层，并为预后增加了另一个维度。
期刊介绍：
ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.
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