Complication Prediction Model Of Percutaneous Transluminal Pulmonary Angioplasty In Patients With Pulmonary Hypertension Associated With Takayasu Arteriti

BackgroundTakayasu’s arteritis associated pulmonary hypertension(TA-PH)is characterized by pulmonary artery stenosis or occlusion due to the involvement of the pulmonary arteries in Takayasu’s arteritis,leading to increased pulmonary artery pressure.The current medical treatment for TA-PH is generally unsatisfactory,and percutaneous transluminal pulmonary angioplasty(PTPA)has been used to reduce overall mortality and improve cardiac function in TA-PH patients.However,PTPA is associated with a relatively high incidence of complications.ObjectiveTo investigate the predictive factors for complications of PTPA in TA-PH patients and establish a predictive model.MethodsA retrospective analysis was conducted on the clinical history,hemodynamic parameters,imaging data,PTPA procedure details,and outcomes of TA-PH patients who underwent PTPA treatment at Peking Union Medical College Hospital or Fuwai Hospital.Pulmonary vascular injury was used as the outcome variable,with each PTPA procedure considered as an individual case.Univariate and multivariate logistic regression analyses were performed on the aforementioned variables to identify predictors with significant value and establish the predictive model.The discriminative ability of the model was evaluated using receiver operating characteristic curves and calculation of the C-index,while calibration was assessed using calibration plots and Brier scores.Internal validation was performed by resampling the development cohort to create an internal validation cohort to evaluate the discriminative ability and calibration of the model.ResultsA total of 52 TA-PH patients with 140 PTPA procedures were included in this study,and pulmonary vascular injury occurred in 25 patients and 33 PTPA procedures.Through univariate and multivariate logistic regression analyses,four variables were selected for inclusion in the predictive model:age,the number of completely occlusive lesions in a single treatment,superior vena cava oxygen saturation,and left ventricular end-diastolic diameter.Two models were established:Model 1(including all four variables)and Model2(excluding left ventricular end-diastolic diameter).Both models were evaluated and validated separately.In the development cohort,Model 1 had a C-index of 0.872 and a Brier score of 0.119,while Model 2 had a C-index of 0.866 and a Brier score of 0.137.In the internal validation cohort,Model 1 had a C-index of 0.853 and a Brier score of 0.130,while Model 2 had a C-index of 0.849 and a Brier score of 0.147.Both models demonstrated good predictive ability in both the development and internal validation cohorts.ConclusionThis study established a predictive model for pulmonary vascular injury during PTPA in TA-PH patients,including age,the number of completely occlusive lesions in a single treatment,superior vena cava oxygen saturation,and left ventricular end-diastolic diameter as variables.The model showed good discriminative ability and calibration performance and can be used as a reference tool for clinicians to formulate individualized PTPA strategies for different patients.