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Risk assessment model for heart failure in Chinese patients with Takayasu's arteritis
Yu-Jiao Wang1, Li-Li Ma1,2, Yun Liu1
1Department of Rheumatology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
Insights
A risk assessment model was developed to identify heart failure (HF) risk in Takayasu
Area of Science:
- Cardiology
- Rheumatology
- Vascular Medicine
Background:
- Takayasu's arteritis (TAK) is a rare, chronic inflammatory disease affecting large arteries.
- Heart failure (HF) is a significant complication in TAK patients, necessitating early identification and risk stratification.
- Understanding risk factors for HF in TAK is crucial for timely intervention and improved patient outcomes.
Purpose of the Study:
- To construct and validate a predictive risk assessment model for heart failure (HF) in patients diagnosed with Takayasu's arteritis (TAK).
- To identify key clinical and laboratory risk factors associated with the development of HF in TAK patients.
Main Methods:
- A cohort of 365 TAK patients was divided into training (2:1 ratio) and validation sets.
- Logistic regression analysis was employed to identify HF risk factors and develop a scoring algorithm.
- The model's predictive accuracy was assessed using Area Under the Curve (AUC) in both training and validation sets.
Main Results:
- Heart failure was observed in 20.27% of TAK patients.
- Identified risk factors for HF in TAK include: onset age >38 years, elevated serum TNF-α (>10 pg/ml), aortic valve involvement, coronary artery involvement, and pulmonary hypertension.
- The developed risk assessment model demonstrated high accuracy (AUC 0.88-0.90 in training, 0.88-0.89 in validation sets).
Conclusions:
- A validated risk assessment model can effectively identify TAK patients at high risk for developing heart failure.
- The model, incorporating factors like age, TNF-α levels, and specific cardiac involvements, aids clinicians in anticipating HF complications.
- Early identification of HF risk in TAK patients allows for targeted management strategies and potentially mitigates adverse cardiovascular events.
Objectives:
We aimed to construct and validate a risk assessment model to identify risk factors for heart failure (HF) in patients with Takayasu's arteritis (TAK).
Methods:
Three hundred sixty-five patients with TAK were recruited in the East China Takayasu Arteritis Cohort from January 2012 to December 2019. Patients were assigned into training and validation sets following a 2:1 ratio according to the date of enrollment. Clinical characteristics were compared between heart failure (HF) and non-HF subgroups in the training set, and a risk assessment model for HF and its scoring algorithm was established based on logistic regression, which was tested in the validation set.
Results:
Among total of 74 (20.27%) TAK patients exhibited HF, and 55 cases (74.32%) were in the training set. The risk factors for HF of TAK patients included onset age >38 years, serum tumor necrosis factor (TNF)-α concentration >10 pg/ml, aortic valve involvement, coronary artery involvement, and pulmonary hypertension. We constructed the model without TNF-α (Model 1) and with TNF-α (Model 2). Patients in the training set with the score ≥ 3 appeared to be associated with an increased risk of HF with an area under curve (AUC) of 0.88 and 0.90 in Model 1 and Model 2 respectively. The AUC reached to 0.88 and 0.89 in the validation set that proved the accuracy of the model.
Conclusions:
We presented a risk assessment model of HF in TAK, which may help clinicians alert the complication of HF in the patients with specifically cardiac impairments. Key Points • Heart failure was not rare in Chinese Takayasu's arteritis patients, and there were approximately 20% of patients with heart failure in ECTA cohort. • Cardiac involvements on echocardiography include pathological valvular and atrioventricular abnormalities. • The onset age >38 years, serum tumor necrosis factor (TNF)-α concentration >10 pg/ml, aortic valve involvement, coronary artery involvement, and pulmonary hypertension were risk factors for heart failure in Takayasu's arteritis patients. • We constructed the model without TNF-α (Model 1) and with TNF-α (Model 2). Patients with the risk assessment model score of ≥ 3 appeared to be associated with an increased risk of heart failure.
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