[Construction of a prediction model of ultrasound indicators for mortality risk within 7 days in patients with acute myocardial infarction and ventricular septal rupture].

Objective: To investigate the risk factors of death within 7 days in patients with acute myocardial infarction (AMI) complicated by ventricular septal rupture (VSR) based on echocardiography indicators, and to construct a nomogram model of ultrasound indicator risk to predict the risk of death in patients with post-infarction ventricular septal rupture (PIVSR).

Methods: The echocardiographic data of 40 patients with PIVSR admitted to the department of cardiology, Xiangya Third Hospital, Central South University from January 2014 to June 2024 were retrospectively analyzed. The patients were divided into death group and survival group based on their 7-day survival status. The risk factors affecting death within 7 days of PIVSR patients were analyzed by univariate and multivariate analyses, and the risk nomogram model of ultrasound indicators predicting death within 7 days of PIVSR patients was constructed by using R software. Calibration curve and receiver operator characteristic curve (ROC curve) were used to verify the prediction effect of the model.

Results: Among the 40 patients with PIVSR, 18 died at 7 days and 22 survived. Univariate analysis showed that, compared with the survival group, patients in the death group were older (years old: 73.7±6.8 vs. 68.1±7.7), had a larger diameter of VSR (mm: 10.4±4.2 vs. 7.7±3.0), and had a higher peak pressure difference (PPG) in the perforation area [mmHg (1 mmHg≈0.133 kPa): 49.0±11.6 vs. 37.0±16.1], left ventricular ejection fraction (LVEF) and stroke volume (SV) were significantly decreased [LVEF: 0.439±0.134 vs. 0.512±0.094, SV (mL): 46.1±15.6 vs. 62.0±14.3], and the differences were statistically significant (all P < 0.05). Multivariate Logistic regression analysis showed that age [odds ratio (OR) = 1.212, 95% confidence interval (95%CI) was 1.034-1.420, P = 0.018] and perforation area PPG (OR = 1.248, 95%CI was 1.069-1.457, P = 0.005) were positively correlated with the occurrence of death events within 7 days in PIVSR patients, while SV was negatively correlated with the occurrence of death events within 7 days in PIVSR patients (OR = 0.851, 95%CI was 0.756-0.957, P = 0.007). The predicted value of the nomogram model for predicting the risk of death within 7 days in patients with PIVSR was basically consistent with the actual value, and the Hosmer-Lemeshow goodness of fit test χ ² = 10.679, P = 0.220. The area under the curve (AUC) predicted by the model was 0.960, 95%CI was 0.913-0.998.

Conclusions: Age and echocardiographic indicators SV and perforation area PPG are risk factors for mortality within 7 days in PIVSR patients. The nomogram model of mortality risk within 7 days in PIVSR patients constructed using the above indicators has good discrimination and consistency.