基于人口统计的个性化左心室缩症 缩性心肌病诊断的门
Hunain Shiwani1, Rhodri H Davies1, Constantin-Cristian Topriceanu2
1Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom.
Journal of the American College of Cardiology
|January 8, 2025
概括
一种新的方法根据个人人口统计学来调整左心室缩 (LVH) 门以诊断高缩性心肌病 (HCM). 这种方法提高了诊断的准确性,并减少了偏差与固定的15毫米墙壁厚度值相比.
科学领域:
- 心脏病学 心脏病学
- 医学诊断 医学诊断 医学诊断
- 生物医学工程 生物医学工程
背景情况:
- 增高性心肌病变 (HCM) 是心脏突然死亡的主要原因.
- 目前的诊断依赖于左心室缩 (LVH) 的固定值 (≥15毫米最大壁厚).
- 这一固定门可能会导致某些人群的诊断偏差.
研究的目的:
- 提出和验证一种用于诊断HCM中的LVH的新方法.
- 该方法根据个人人口因素 (年龄,性别,身体表面积) 调整了LVH值.
- 为当前一刀切的诊断方法提供替代方案.
主要方法:
- 左心室最大壁厚度 (MWT) 用心血管磁共振 (CMR) 和人工智能测量了三个队列:健康成年人 (n=5,067),一般人群 (n=43,239) 和高血压患者 (n=2,424).
- 一个参考队列被用来开发人口调整的LVH值和个性化的z-score.
- 这些调整的值和z分数应用于人口和HCM队列,以评估诊断准确性和偏差.
主要成果:
- 传统的≥15毫米LVH值高估了一般人群的缩 (4.3%,89%男性) 并显示出显著的性别偏差.
- 根据人口统计学调整的值 (10-17毫米范围) 降低了整体确定率 (2.2%) 和性别偏差 (56%男性).
- 调整的值改善了HCM诊断,减少了女性患者 (从27%降至7%) 和男性患者 (从18%降至15%) 的错误分类,MWT低于15毫米.
结论:
- 正常的心脏MWT受到个人人口统计学因素的影响,如年龄,性别和体型.
- 固定的LVH值≥15毫米在一般人群和HCM人群中引入了显著的确定偏差.
- 人口调整的LVH值提高了诊断准确度,减少了HCM识别方面的偏差.
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