Development and Validation of a Nomogram Model Affecting the ACT Targeting Rate During Radiofrequency Ablation of Atrial Fibrillation in China.

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular Drugs and Therapy Pub Date : 2024-12-01 Epub Date: 2023-05-09 DOI:10.1007/s10557-023-07450-3

Shiyun Tang, Xiaoqin Hu, Wei Bao, Fei Li, Liqi Ge, Hui Wei, Quan Zhang, Baixiang Zhang, Chaoqun Zhang, Zhirong Wang, Chengzong Li

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Abstract

Context: A nomogram model affecting the activated clotting time (ACT) targeting rate during radiofrequency ablation of atrial fibrillation (RFCA) in China.

Purpose: The aim of this study is to develop and validate a nomogram model for predicting the activated clotting time targeting rate after the initial bolus heparin dosages during the radiofrequency catheter ablation of atrial fibrillation in China.

Methods and results: A retrospective observational study was conducted on the data of 465 patients with atrial fibrillation who underwent radiofrequency catheter ablation (RFCA) from October 2019 to June 2022. All patients were randomized into a training cohort (70%; n = 325) and a validation cohort (30%; n = 140). Independent risk factors were identified using univariate and multifactorial logistic regression analysis. The predictive nomogram model was established using R software. The nomogram was developed and evaluated based on differentiation, calibration, and clinical efficacy using concordance statistic (C-statistic), calibration plots, and decision curve analysis (DCA), respectively. The nomogram was established using three variables, including sex (OR 1.01, 95% CI 0.29-1.76, P = 0.007), heparin dose (OR 0.04; 95%CI 0.02-0.05, P < 0.001), and the baseline ACT (OR 0.03; 95%CI 0.02-0.04, P < 0.001). The C-statistic of the nomogram was 0.736 (95%CI 0.675-0.732) in the training cohort and 0.700 (95%CI 0.622-0.721) in the validation cohort. The calibration plots showed good agreement between the predictions and observations in the training and validation cohorts. The clinical decision curve also proves that the map is useful in clinical settings.

Conclusion: The nomogram model has good discrimination and accuracy, which can screen attainment groups intuitively and individually, and has a certain predictive value for the probability of ACT reaching the target after the adequate dosage of initial heparin in Chinese patients with atrial fibrillation.

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影响心房颤动射频消融过程中ACT靶向率的Nomogram模型的建立与验证。

背景：一个影响中国心房颤动射频消融（RFCA）过程中活化凝血时间（ACT）靶向率的nomogram模型。目的：本研究的目的是建立并验证一种预测中国心房颤动射频导管消融过程中初始肝素剂量后激活凝血时间靶向率的nomogram模型。方法与结果：对2019年10月至2022年6月接受射频导管消融（RFCA）治疗的465例心房颤动患者的资料进行回顾性观察研究。所有患者随机分为训练队列(70%；N = 325)和验证队列(30%；N = 140)。采用单因素和多因素logistic回归分析确定独立危险因素。采用R软件建立预测模态图模型。分别采用一致性统计（C-statistic）、校准图和决策曲线分析（DCA），建立并评估基于鉴别、校准和临床疗效的nomogram。采用性别（OR 1.01, 95% CI 0.29-1.76, P = 0.007）、肝素剂量(OR 0.04；95%CI 0.02-0.05, P < 0.001)，基线ACT (OR 0.03；95%ci 0.02-0.04, p < 0.001)。训练组c -统计量为0.736 (95%CI 0.675 ~ 0.732)，验证组c -统计量为0.700 （95%CI 0.622 ~ 0.721）。校正图显示，在训练和验证队列中，预测和观察结果之间具有良好的一致性。临床决策曲线也证明了该地图在临床设置中是有用的。结论：所建立的nomogram模型具有良好的辨别力和准确性，可以直观地、个性化地筛选获得群体，对我国房颤患者初始肝素剂量足够后ACT达到目标的概率具有一定的预测价值。

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来源期刊

Cardiovascular Drugs and Therapy 医学-心血管系统

CiteScore

8.30

自引率

0.00%

发文量

110

审稿时长

4.5 months

期刊介绍： Designed to objectively cover the process of bench to bedside development of cardiovascular drug, device and cell therapy, and to bring you the information you need most in a timely and useful format, Cardiovascular Drugs and Therapy takes a fresh and energetic look at advances in this dynamic field. Homing in on the most exciting work being done on new therapeutic agents, Cardiovascular Drugs and Therapy focusses on developments in atherosclerosis, hyperlipidemia, diabetes, ischemic syndromes and arrhythmias. The Journal is an authoritative source of current and relevant information that is indispensable for basic and clinical investigators aiming for novel, breakthrough research as well as for cardiologists seeking to best serve their patients. Providing you with a single, concise reference tool acknowledged to be among the finest in the world, Cardiovascular Drugs and Therapy is listed in Web of Science and PubMed/Medline among other abstracting and indexing services. The regular articles and frequent special topical issues equip you with an up-to-date source defined by the need for accurate information on an ever-evolving field. Cardiovascular Drugs and Therapy is a careful and accurate guide through the maze of new products and therapies which furnishes you with the details on cardiovascular pharmacology that you will refer to time and time again.