Development and Validation of a Nomogram for Estimating Stroke Risk in Nonvalvular Atrial Fibrillation Patients With Left Atrial Stiffness: A Single-Center Cross-Sectional Study

IF 2.8 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Therapeutics Pub Date : 2026-07-16 DOI:10.1155/cdr/8877050

Decai Zeng, Xiangling Cao, Yongzhi Cai, Tongtong Huang, Shuai Chang, Bingling Wu, Ji Wu

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Abstract

Background

Nonvalvular atrial fibrillation (NVAF) is a prevalent arrhythmia associated with an increased risk of ischemic stroke. This study is aimed at assessing the clinical significance of echocardiographic left atrial (LA) stiffness and developing a nomogram integrating clinical and echocardiographic parameters to evaluate individualized stroke risk in NVAF patients.

Methods

We enrolled 402 consecutive NVAF patients between January 2020 and March 2023. Clinical and echocardiographic data were collected, and patients were randomly assigned to training (n = 281) and validation (n = 121) datasets. Univariate and multivariate logistic regression identified independent stroke risk factors, which were used to construct a nomogram. Model performance was evaluated by receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis. The reclassification ability of the nomogram was assessed using integrated discrimination improvement (IDI) and net reclassification improvement (NRI).

Results

Logistic regression identified LA stiffness, LA reservoir strain, hypertension, peripheral vascular disease, and anticoagulation as independent factors associated with stroke. The nomogram based on these factors showed excellent discrimination, with a C-statistic of 0.889 (0.847–0.924) in the training cohort and 0.880 (0.808–0.932) in the validation cohort. Model A (LA stiffness, LA reservoir strain, hypertension, peripheral vascular disease, and anticoagulation) provided better net reclassification and integrated discrimination than Model B (LA stiffness, LA reservoir strain, hypertension, and peripheral vascular disease) despite both outperforming the CHA₂DS₂-VASc model. LA stiffness was inversely correlated with left atrial appendage (LAA) emptying (R = −0.52, p < 0.01) and filling velocities (R = −0.50, p < 0.01). Patients with LA thrombus or spontaneous echocardiographic contrast exhibited significantly higher LA stiffness (p < 0.05).

Conclusion

A nomogram incorporating LA stiffness, LASr, hypertension, and peripheral vascular disease can effectively identify the risk of stroke in NVAF patients. Additionally, a secondary model including anticoagulation showed further improved performance but requires prospective validation. Elevated LA stiffness might play a role in the development of stroke in NVAF by influencing LA appendage hemodynamics.

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非瓣膜性心房颤动左心房僵硬患者卒中风险的Nomogram评估与验证：一项单中心横断研究

背景：非瓣膜性心房颤动（NVAF）是一种常见的心律失常，与缺血性卒中风险增加有关。本研究旨在评估超声心动图左心房（LA）僵硬度的临床意义，并开发一种综合临床和超声心动图参数的nomogram方法来评估非瓣膜性房颤患者的个体化卒中风险。方法：在2020年1月至2023年3月期间，我们招募了402例连续的非瓣膜性房颤患者。收集临床和超声心动图数据，并将患者随机分配到训练（n = 281）和验证（n = 121）数据集。单因素和多因素逻辑回归确定了独立的卒中危险因素，并用于构建nomogram。通过受试者工作特征（ROC）曲线、校正曲线和决策曲线分析评价模型的性能。采用综合判别改进（IDI）和净重分类改进（NRI）评价nomogram重分类能力。结果Logistic回归发现LA僵硬、LA库应变、高血压、外周血管疾病和抗凝是与脑卒中相关的独立因素。基于这些因素的方差图具有很好的判别性，训练组和验证组的c统计量分别为0.889（0.847-0.924）和0.880（0.808-0.932）。模型A （LA刚度、LA库应变、高血压、周围血管疾病和抗凝）比模型B （LA刚度、LA库应变、高血压和周围血管疾病）提供了更好的净重分类和综合区分，尽管两者都优于CHA2DS2-VASc模型。左心耳刚度与左心耳（LAA）排空（R = - 0.52, p < 0.01）和充血速度（R = - 0.50, p < 0.01）呈负相关。有LA血栓或自发超声心动图对比的患者LA僵硬度明显更高（p < 0.05）。结论结合LA僵硬度、LASr、高血压和周围血管病变的nomogram心电图可有效识别非瓣膜性房颤患者的卒中风险。此外，包括抗凝在内的二级模型显示出进一步改善的性能，但需要前瞻性验证。左心室僵硬度升高可能通过影响左心室附属物血流动力学而参与非瓣膜性房颤卒中的发生。

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来源期刊

Cardiovascular Therapeutics 医学-心血管系统

CiteScore

5.60

自引率

0.00%

发文量

审稿时长

6 months

期刊介绍： Cardiovascular Therapeutics (formerly Cardiovascular Drug Reviews) is a peer-reviewed, Open Access journal that publishes original research and review articles focusing on cardiovascular and clinical pharmacology, as well as clinical trials of new cardiovascular therapies. Articles on translational research, pharmacogenomics and personalized medicine, device, gene and cell therapies, and pharmacoepidemiology are also encouraged. Subject areas include (but are by no means limited to): Acute coronary syndrome Arrhythmias Atherosclerosis Basic cardiac electrophysiology Cardiac catheterization Cardiac remodeling Coagulation and thrombosis Diabetic cardiovascular disease Heart failure (systolic HF, HFrEF, diastolic HF, HFpEF) Hyperlipidemia Hypertension Ischemic heart disease Vascular biology Ventricular assist devices Molecular cardio-biology Myocardial regeneration Lipoprotein metabolism Radial artery access Percutaneous coronary intervention Transcatheter aortic and mitral valve replacement.