Establishment Of The Nomogram Prediction Model For The Development Of Right Heart Failure From Arterial Pulmonary Hypertension

Objective: To identify the risk factors in developing right heart failure(RHF)in patients with pulmonary arterial hypertension(PAH)and construct a nomogram model for predicting risk of developing RHF in PAH patients.Methods: Admitted to the First Affiliated Hospital of Xinjiang Medical University during the span from January 2014 to December 2021,63 patients with idiopathic pulmonary arterial hypertension(IPAH)and systemic lupus erythematosus associated pulmonary arterial hypertension(SLE-PAH)are retrospectively analyzed.Using symptoms and signs of right heart failure,NT-pro BNP ≥465ng/L,and right ventricular structural and functional abnormalities suggested by cardiac ultrasound as criteria for RHF,patients are divided into 26 cases of PAH patients with RHF and 37 cases without.By analyzing the general clinical data,laboratory indexes and cardiac ultrasound indexes of the two groups,the independent risk factors for RHF in PAH patients are obtained by univariate and multivariate logistic regression analysis.The R language software(R4.2.1)is used to build and verify the nomogram prediction model.Results: Compared with the second group,PAH patients with RHF were of younger age,they have lower systolic and diastolic blood pressure and serum ferritin,rising lymphocyte count and monocyte count,decreased triglyceride,total cholesterol,high-density lipoprotein(HDL)and low-density lipoprotein,higher total bilirubin,indirect bilirubin,alanine aminotransferase and serum prothrombin time,and lower erythrocyte sedimentation rate.Also,right atrial diameter,right ventricular diameter,right ventricular outflow tract diameter and pulmonary artery pressure are increased,while the left ventricular end diastolic diameter,left ventricular end systolic diameter,MV-E/e ’,and stroke volume are decreased(P<0.05).The regression analysis showed that high-density lipoprotein(HDL),left ventricularend diastolic diameter(LVDD)and pulmonary artery systolic pressure are independent in the development RHF in PAH patients.The nomograph model was constructed using the indicators above,and the internal validation method was validated by Bootstrap repeated sampling 1000 times.It is found that the predicted value is mostly consistent with the measured value,indicating that the prediction model established in this study shows high consistency;The calculated C-index is 0.897(95% CI:0.815～0.979),which had good discrimination.The area under the ROC curve of the prediction model is 0.898,with high prediction efficiency.Conclusion: The risk of developing RHF in PAH patients with decreased high-density lipoprotein,decreased left ventricular end diastolic diameter,and elevated pulmonary artery systolic pressure is evidently higher.The nomogram model constructed in this study is conducive to the assessment of the risk of developing RHF in PAH patients,and holds significance in clinical application.