News

YPE html PUBLIC “-//W3C//DTD XHTML+RDFa 1.0//EN” “http://www.w3.org/MarkUp/DTD/xhtml-rdfa-1.dtd”>
Chinangwa Kuongorora mashandiro ekuongorora kweN-terminal B-type natriuretic peptide precursor (NT-proBNP) pachikumbaridzo mukutadza kwemoyo wakanyanya, uye kugadzira nekusimbisa chishandiso chekutsigira sarudzo chinobatanidza NT-proBNP kusungwa nezviratidzo zvekiriniki.
Yakaita zvidzidzo zve14 kubva kunyika gumi nenhatu, kusanganisira zviedzo zvakadzorwa zvisina tsarukano uye zvidzidzo zvekutarisa zvinotarisirwa.
Yega-yemunhu-yemwero data kubva ku10 kusvika kuvarwere ve369 vane fungidziro yekutadza kutadza kwemoyo vakaunganidzwa kuti vaongororwe meta-yekufungidzira NT-proBNP kucheka-kubvisa.Chishandiso chekutsigira sarudzo (Heart Failure Diagnosis uye Evaluation Collaboration (CoDE-HF)), iyo inobatanidza NT-proBNP nemakiriniki akasiyana-siyana kuzivisa mukana wekutadza kwemoyo wakaoma mumurwere wega wega, yakagadziridzwa uye yakasimbiswa.
Results.Kakawanda, 43.9% (4549/10 ~ 369) yevarwere vakaonekwa kuti vane acute heart failure (73.3% (2286/3119) uye 29.0% (1802/6208) yevarwere vane uye vasina kukundikana kwemoyo isati yasvika).iyo manejimendi inokurudzirwa kucheka-kubvisa chikumbaridzo che300 pg/mL ine yakashata yekufungidzira kukosha kwe94.6% (95% nguva yekuvimba, 91.9% kusvika 96.4%); pasinei nekushandiswa kwezera rekutonga-muzvikumbaridzo, iyo yakanaka yekufungidzira kukosha kwakasiyana pa 61.0% (55.3% kusvika 66.4%), 73.5% (62.3% kusvika 82.3%), uye 80.2% (70.9% kusvika 87.1%), muvarwere vane makore <50 makore, 50-75 makore, uye> 75 makore, zvichiteerana. pasinei nekushandiswa kwezera rekutonga-muzvikumbaridzo, kukosha kwekufanotaura kwakanaka kwakasiyana pa 61.0% (55.3% kusvika 66.4%), 73.5% (62.3% kusvika 82.3%), uye 80.2% (70.9% kusvika 87.1%), muvarwere ane makore <50 makore, 50-75 makore, uye> 75 makore, zvichiteerana. Несмотря на использование возрастных порогов правил, положительная прогностическая ценность варьировала в 61,0% (от 55,3% 4д, 6, 8% , 6, 3%, 6, 8% (kubva pa70,9% kusvika 87,1%) у пациентов в возрасте <50 лет, 50-75 лет и >75 лет соответственно. Pasinei nekushandiswa kwemazera emakore mumitemo, iyo yakanaka yekufungidzira kukosha kwakasiyana mu61.0% (kubva pa55.3% kusvika 66.4%), 73.5% (kubva pa62.3% kusvika 82.3%) uye 80.2% (kubva pa70.9% kusvika 87.1%) muvarwere ane makore <50 makore, 50-75 makore uye> 75 makore, zvichiteerana.Zvisinei nekushandiswa kwezera mumutemo, pakati pevarwere vakura, maitiro akanaka ekufungidzira aive 61.0% (renji 55.3% kusvika 66.4%), 73.5% (renji 62.3% kusvika 82.3%) uye 80. 2% (kubva pa70.9) % kusvika 87.1%).) kuchinja pakati. <50 岁、50-75 岁和>75 岁。 <50岁、50-75岁和>75岁. <50 лет, 50-75 лет и >75 лет. <50 makore, 50-75 makore uye> 75 makore.Kuratidzwa kwekiriniki kwakasiyana mumapoka madiki, kunyanya mumapoka ane kufutisa, kusakwana kwerenal, kana nhoroondo yekutadza kwemoyo.CoDE-HF yakarongedzerwa zvakanaka uye yaive nerusarura rwakanyanya pakati pevarwere vane uye vasina nhoroondo yekutadza kwemoyo (nzvimbo iri pasi peanogamuchira anoshanda curve 0.846 (0.830 kusvika 0.862) uye 0.925 (0.919 kusvika 0.932), zvichiteerana, uye Brier mamakisi e0.130 uye 0.099, zvichiteerana).)Muvarwere vasina kutadza kwemoyo kusati kwaitika, kuongororwa kwaienderana nemapoka ese ane mukana wakaderera we40.3% (2502/6208) (negative predictive value 98.6%, 97.8% kusvika 99.1%) uye 28.0% (1737/6208) mukana we acute heart failure yaive yakakwira (positive predictive value 75.0%, 65.7% kusvika 82.5%).
Mhedziso Mukuongorora kwekudyidzana kwenyika dzakawanda kwekuongorora kwekuita kweNT-proBNP, zvikumbaridzo zvinokurudzirwa mumirayiridzo yekuongorora kutadza kwemoyo zvakanyanya zvakasiyana-siyana pakati pezvikamu zvakakosha zvevarwere.Iyo CoDE-HF Decision Support Tool inobatanidza NT-proBNP muzviyero zvinoenderera uye zvimwe zvakasiyana-siyana zvekiriniki, zvichipa nzira inowirirana, yakarurama uye yemunhu.
Vanosvika miriyoni imwe vanhu muUK vanotambura nekutadza kwemoyo uye kuwanda kunotarisirwa kukwira ne50% mumakore makumi maviri anotevera nekuda kwehuwandu hwekuchembera.1 Decompensated acute heart failure inobata 5% yezvese zvisina kurongeka muzvipatara.2 Kuongororwa kwakarurama uye panguva yakakodzera yeacute heart failure inogona kuva yakaoma, uye nhungamiro yenyika uye yepasi rose inokurudzira kuongororwa kwe natriuretic peptides kubatsira mukuongororwa.345678 Zvisinei nekurudziro idzi, kuyedzwa kweN-terminal B-type natriuretic peptide precursor (NT-proBNP) haina kugaroitwa, muchidimbu nekuda kwekunetsekana nezvekubatsira kwayo kwekiriniki munyika chaiyo.Zvidzidzo zvekuongorora maitiro ekuongorora kweNT-proBNP zvakanyanya kuitwa mumapoka madiki akasarudzwa evarwere, izvo zvinoganhurira kugona kuburitsa mhedzisiro kumapoka akakosha ekiriniki, akadai sevarwere vakura nevarwere vane renal insufficiency kana kufutisa, uko maitiro aya anosiyana. zvakanaka.kuwedzera kuwanda kune varwere vane moyo kukundikana.91011 Statistical modeling nzira dzinofunga nezvehutano hwevarwere kuti dzipe humwe huwandu hwekufungidzira hunogona kunge huine humwe hunoita hunoenderana nehutachiona hwekushanda kune zvikamu zviduku zvevarwere.12
Kunyange zvazvo mhando dzakawanda dzakagadzirwa kuti dzifanotaura kufungidzira kune varwere vane mwoyo kukundikana, vashomanana vanogona kubatsira kuongorora kukanganisa kwemoyo.13141516171819 Kuedza kwakapfuura kwakave nezvakanakira zvakawanda asi kwakabatanidza zvinosiyana-siyana senge makiriniki 'pre-test probabilities kana murwere tsananguro yezviratidzo.Mukuwedzera, ivo vaisanganisira NT-proBNP sechinhu chinoshanduka chebhinari uye havana kutora munhoroondo yekushandura uye kusina-mutsara kupindirana pakati peNT-proBNP uye mamwe makiriniki akasiyana.Kuedza kwakapfuura kukudziridza uye kusimbisa zviyero zvekuongorora zvakabatanidzawo nhamba shoma yevarwere kubva kune imwe nzvimbo, iyo yakadzivisa kuongororwa kwehutano mukati mezvikamu zviduku uye kuderedza mukana wekunze kwekunze.
Mukuongorora uku kwekudyidzana kwenyika dzese, takaongorora mashandiro ekuongorora kweiyo nhungamiro 'inokurudzirwa NT-proBNP zvikumbaridzo zveacute heart failure mune subset yevarwere.Mushure mezvo, takagadzira uye takasimbisa chishandiso chekutsigira sarudzo kune varwere vane fungidziro yekutadza kutadza kwemoyo iyo yakashandisa mufananidzo wenhamba kubatanidza NT-proBNP kutariswa nekiriniki maitiro.
Takaita ongororo yakarongeka kuti tione zvidzidzo zvinoongorora maitiro ekuongorora kweNT-proBNP kune varwere vane fungidziro yekutadza kwemoyo.Takagadziridza wongororo yapfuura naRoberts et al1 kuti ibatanidze mazwi akakosha "kutadza kwemoyo" uye "natriuretic peptides" nekutsvaga Embase, Medline, uye Cochrane Central Rejista yeDzidzo Inodzorwa yemazita uye zvinyorwa zvakaburitswa musi wa18 Nyamavhuvhu 2021 (Supplementary Text 1) .Zvidzidzo zvaionekwa sezvinokodzera kana zvakasangana neanotevera akatemerwa kuisirwa maitiro: kunyoreswa kwevarwere vane makore ≥18 vane fungidziro yekutadza kwemoyo munjodzi yekukurumidzira, kuyerwa kweNT-proBNP mumasampuli eropa akawanikwa panguva yekuongororwa kwekutanga kwemurwere pazuva rekubvumidzwa, uye Kuongororwa kweacute heart failure kwakaitwa pachishandiswa miitiro inogamuchirika.Vaongorori vaviri (KKL neMA) vakaongorora vakazvimiririra zvidzidzo zvese zvakaonekwa nehurongwa hwekutsvaga mabhuku, uye wechitatu (NLM) akaita sarudzo yekunetsana vachishandisa predefined protocol (PROSPERO registry: CRD42019159407).
Isu takabata vanyori vakasiyana kune ese anokodzera cohorts kukumbira ruzivo nezve NT-proBNP kutariswa, yakasimbiswa kuongororwa kweacute heart failure, demographics (zera, murume kana mukadzi, rudzi), nhoroondo yekutanga (kutadza kwemoyo, coronary artery disease, asingazivikanwe murwere wega level).data pamusoro pechirwere cheshuga), hypertension, hyperlipidemia, kusvuta, asima, chisingaperi chinovharidzira chirwere chemapapu, chirwere cheitsvo chisingaperi), physiological parameters (kurova kwemwoyo uye ropa) pakuongororwa kwekutanga, kliniki yehematological uye biochemical maitiro.Takatarisa nevanyori vese vakakodzera nezvechokwadi, tsananguro dzezvakasiyana, uye kukwana kusati kwabvumirana.Zvidzidzo zvose zvakaitwa maererano neDeclaration of Helsinki uye zvakabvumirwa netsika kuti zvibvumire kugoverana kwedheta pamunhu mumwe nomumwe murwere nokuda kweiyi meta-analysis.Vatsvakurudzi vaviri (KKL neMA) vakazvimiririra vakaongorora njodzi yekusarura kwechidzidzo chega chega vachishandisa Chidzidzo cheChidzidzo Chekuongorora Chiyero muDiagnostic Accuracy, version 2 (QUADAS-2), uye 20 makakatanwa akagadziriswa nevechitatu (NLM).
Isu takatora meta-yekufungidzira ine 95% nguva yekuvimba yekunzwa, chaiyo, yakaipa yekufungidzira kukosha, uye yakanaka yekufungidzira kukosha kwegwaro rinokurudzirwa NT-proBNP kutonga-kunze chikumbaridzo (300 pg/mL) 58 uye zera chairo-mune zvikumbaridzo. 450, 900, uye 1800 pg/mL yevarwere vane makore <50, 50-75, uye> 75 makore, zvichiteerana) 7 nokuda kwekushaya mwoyo kwakanyanya kuburikidza nekushandisa nzira mbiri, pamwe nekufungidzira kwakaverengwa zvakasiyana mukati mekudzidza kwega kwega ndokuzobatanidzwa pane zvidzidzo. mune binomial-yakajairika random effects modhi tichishandisa nzira yeDerSimonian neLaird.21 Takaongororazve kushanda kwezvikumbaridzo izvi muzvikamu zvakagara zvataurwa zvakarongwa nezera, zvepabonde, dzinza, body mass index, renal function, anemia, uye kuvapo kwe comorbidities (kutadza kwemoyo kwakapfuura, hypertension, hyperlipidemia, chirwere cheshuga mellitus, atrial fibrillation, chisingaperi chinodzivirira pulmonary chirwere). Мы получили метаоценки с 95% доверительными интервалами чувствительности, специфичности, отрицательной прогностической ценности и положительной прогностической ценности рекомендуемого порога исключения NT-proBNP (300 пг/мл)58 и возрастных порогов исключения ( 450, 900 и 1800 пг/мл для пациентов в возрасте < 50, 50-75 и >75 лет соответственно)7 для острой сердечной недостаточности с использованием двухэтапного подхода, при этом оценки рассчитываются отдельно в каждом исследовании, а затем объединяются по исследованиям.в модели биномиально-нормальных случайных эффектов с использованием метода ДерСимониана и Лэрда.21 Далее мы оценили эффективность этих пороговых значений в предварительно определенных подгруппах, стратифицированных по возрасту, полу, этнической принадлежности, индексу массы тела, функции почек, анемии и наличию сопутствующие заболевания (сердечная Недостаточность в анамнезе, артериальная гипертензия, гиперлипидемия, сахарный диабет, мерцательная аритмия, хронибленский песни.我们 对 指南 推荐 推荐 推荐 NT-Probnp 排除 阈值 (300 PG / ML) 58 和 年龄 <50-75 和> 75 岁 的 患者, 急性 心力 衰竭 分别 为 450,900 × 1800 PG 1800 PG 1800 PG 1800 PG 1800 PG 1800 PG 1800 PG 1800 PG 1800 PG 1800 PG 1800 PG / ML) 7, 采用 两 阶段 方法, 每 每 项 研究 中 分别 计算, 然后 在 研究 中 汇总 在 使用 Derdimonian 和 二 项式 项式 正态 随机 了按年龄、性别、种族、体重指数、肾功能、贫血和存在合并症（既往心力衰竭、高血压、高脂血症、糖尿病、心房颤动、慢性阻塞性肺病）。我们 对 指南 指南 的 NT-Probnp 排除 阈值 (300 Пг (300) 58 和 (对于 年龄 <55-75 和> 75 岁, 急性 心力 分别 450, 心力 和 1800 ) 7, 采用 阶段 方法, 每 项 研究 研究 研究 中 中 汇总 使用 使用 使用 二 项式 二 项式 随机 随机 随机评估 按 年龄 性别, 种族, 体重 指数, 功能, 和, 和, 和 存在 合并症 (心力和 合并症, 心 血压 高脂血症, 心 心 房 颤动 慢性 性 肺病 肺病) ....使用 相同 方法, 我们 随后 评估 评估 NT-Probnp 浓度 系列 浓度 浓度 范围 的 性能 性能, 以 排除, 阈值 阈值 确定 最 比例 患者 具有 的 的 的 的 的
Isu takaverenga kukosha (0-100) inoenderana nemukana wekuvandudza acute heart failure mumurwere wega wega achishandisa statistical modeling.Nekuda kwekusiyana kwakakura mukuwanda kwecomorbidities uye acute moyo kutadza, isu takagadzira uye akasimbisa mamodheru kune varwere vane uye vasina kutadza kwemoyo, zvichiteerana.Isu takashandisa NT-proBNP kutariswa seyero inoenderera uye takasarudza zviri nyore chinangwa chekiriniki zvinosiyana zvinozivikanwa kuti zvine chekuita neacute moyo kutadza kwaive kwakakoshera zvakanyanya panguva yekudzidziswa kwemuenzaniso wedu (zera, inofungidzirwa glomerular filtration rate, hemoglobin, mass index miviri. ), kurova kwemwoyo, kuwedzera kweropa, peripheral edema, chirwere chisingaperi chinodzivirira pulmonary uye ischemic heart disease) (Supplementary text 2).
Mukugadzira Code-HF, takaongorora mhando ina dzakasiyana dzenhamba: Generalized Linear Mixed Models, Naive Bayes, Random Forest, uye Extreme Gradient Boost (XGBoost) (Supplementary Text 2).222324 Kuzvidavirira nokuda kwekushayikwa kwedata muzvidzidzo (Supplementary Figure A), isu takawanza akaverengerwa dhataseti gumi tichishandisa yakabatana modeled multiple imputation ine randomized study-specific covariance matrix inoenderana neMonte Carlo Markov cheni algorithm.25 Isu takaita kuverengera kwakawanda kune ese akasiyana anosanganisirwa mumuenzaniso kunze kweNT-proBNP.Takaita 10 iterations ye10-fold cross-validation yemuenzaniso wega wega uye takashandisa fungidziro yepakati peiyo iteration uye imputed datasets seCoDE-HF fungidziro yemurwere wega wega.Zvadaro, takaona zvibodzwa zvakaronga chikamu chikuru chevarwere vane mukana wepamusoro kana wakaderera wekushaya mwoyo kwakanyanya, nekushanda kwakanakisisa kwekuregererwa (75% yakanaka yekufungidzira kukosha uye 90% chaiyo) uye nekuregererwa (98% yakaipa yekufungidzira kukosha uye 90). % chaiyo) % senitivity) mukutadza kwemoyo kwakanyanya.
Isu takaongorora mashandiro emuenzaniso wega wega pamhando yekuongorora metrics (nzvimbo iri pasi peanogamuchira anoshanda curve, Brier mamakisi, chikamu chevarwere vanowana yakakwirira uye yakaderera mukana wepamusoro maitiro, uye yakanaka uye yakaipa fungidziro hunhu hwemapoka evarwere).Chibodzwa cheBrier irusarura uye chiyero chekuenzanisa chinoverengerwa nekutora chiyero chakakanganisika pakati pezvinogoneka zvakafanotaurwa nezvakaonekwa.26 Isu takasarudza iyo inonyanya kushanda modhi yeCode-HF sarudzo yekutsigira chishandiso.Isu tinoongorora mashandiro eCoDE-HF tichishandisa sarudzo curve ongororo uye yemukati nekunze kuyambuka-kusimbisa.Muchidimbu, nzira iyi inoregeredza chidzidzo chimwe chete panguva yekusimbiswa kwekunze uye inoshandisa zvidzidzo zvakasara kugadzira modhi.27 Hatina kuisa kukosha mumaseti akasimbiswa ekunze uye saka hatina kusimbisa kunze kune zvakawanda zvezvidzidzo.Iyo yakasiyana yakanga isipo zvachose (Supplementary Figure A).Takashandisa R vhezheni 4.1.2 kune ese ongororo.
Varwere uye nhengo dzekomisheni yeruzhinji vakapinda mukududzirwa kwemhedzisiro.Pane zvirongwa zvekuparadzira zvabuda kunharaunda yevarwere yakakodzera.
Takabata vaongorori kubva kuzvidzidzo makumi matatu zvakakodzera, avo 19 vakapindura.Zvidzidzo gumi nezvina (12 inotarisirwa zvidzidzo zveboka uye miedzo miviri yakarongeka) yakapa munhu mumwe nomumwe-yepamusoro data kubva ku10 kusvika kuvarwere ve369 vane fungidziro yemoyo yakaoma (kureva makore 69.3; 53.3% varume) kubva kunyika dze13 (Table 1).Mufananidzo B;Supplementary Tables A uye B) 15282930313233334353637383940 Zvidzidzo zvose zvakaitwa mudhipatimendi rekukurumidzira, kunze kwechidzidzo chimwe chaisanganisira cardiac uye pulmonary inpatients (kureva varwere ve488 pakudzidza (quartile. Bit spacing 322-1053) .Kakawanda, 43.9% (4549 / 10,369) yevarwere vane chirwere chakasimbiswa chekushaya mwoyo kwakanyanya (median study prevalence 46% (31-54%)).Muvarwere vane mwoyo isati yapera, chiitiko chekushaya simba kwemoyo kwakakwirira kudarika kune varwere vasina kukanganisa kwemoyo (73.3% (2286 / 3119) vs. 29.0% (1802 / 6208)) (Supplementary Table C).
Baseline maitiro evarwere vakaomeswa nekuongororwa kweacute moyo kusakundikana.Values ​​inhamba (percentages) kunze kwekunge zvataurwa neimwe nzira
Pagwaro rinokurudzirwa kusabatanidzwa pachikumbaridzo che300 pg/mL, iyo yakasanganiswa meta-yekufungidzira yeakaipa yekufungidzira kukosha, sensitivity, yakanaka yekufungidzira kukosha, uye chaiyo yeNT-proBNP muhuwandu hwevanhu yaive 94.6% (95% nguva yekuvimba, 91.9%). .kusvika 96.4%), 96.8% (kubva 94.6% kusvika 98.1%), 62,9% (kubva 51.3% kusvika 73.3%) uye 49.3% (kubva 35.4% kusvika 63.4%) (Figure 1; Supplementary Tafura D).Kakawanda, 30.4% (3148/10,369) yevarwere vaiva neNT-proBNP mazinga ari pasi pe300 pg/mL.Zvisinei, paive nechiratidzo chehterogeneity pakati pemapoka evarwere uye zvidzidzo (Mufananidzo 2; Mufananidzo 3; Supplementary Figures C uye D).Hunhu husina kunaka hwekufungidzira hwaive hwakaderera muvarwere ≥75 yemakore (88.2%, kubva 83.5% kusvika 91.8%), pamwe nevarwere vane nhoroondo yekutadza kwemoyo (79.4%, kubva 68.4% kusvika 87.3%) uye kufutisa. (90.4%, kubva 84.5% kusvika 87.3%).94.2%.
N-terminal chikumbaridzo chepro-B-mhando natriuretic peptide (NT-proBNP) mukutadza kwemoyo kwakanyanya.Kumusoro kuruboshwe: Negative predictive value yeNT-proBNP concentration yekusabvisa kuongororwa kweacute heart failure.Pazasi kuruboshwe: Kuwedzera chikamu chevarwere vane fungidziro yekutadza kusimba kwemoyo ine NT-proBNP yakadzika pasi pechikumbaridzo chega chega.Pamusoro kurudyi: Positive predictive value yeNT-proBNP concentration yekuongororwa kweacute heart failure.Pazasi kurudyi: Kuwedzera chikamu chevarwere vane fungidziro yekutadza kusimba kwemoyo ine NT-proBNP yakawandisa pamusoro pechikumbaridzo chega chega.
Kuongororwa kwemaitiro emitemo-yakakurudzirwa N-terminal thresholds yepro-B-type natriuretic peptide mumapoka evarwere: kusakosha kwekufungidzira kukosha kwe300 pg / mL.COPD = chirwere chisingaperi chinodzivirira pulmonary;eGFR = inofungidzirwa glomerular filtration rate
Kuongororwa kwekuita kwegwaro rinokurudzira NT-proBNP zvikumbaridzo pamapoka madiki evarwere: yakanaka yekufungidzira kukosha kwezera rakananga zvikumbaridzo pamapoka evarwere (450, 900, uye 1800 pg/mL ye <50, 50-75, uye> 75 makore, zvichiteerana). Kuongororwa kwekuita kwegwaro rinokurudzira NT-proBNP zvikumbaridzo pamapoka madiki evarwere: yakanaka yekufungidzira kukosha kwezera rakananga zvikumbaridzo pamapoka evarwere (450, 900, uye 1800 pg/mL ye <50, 50-75, uye> 75 makore, zvichiteerana). Диагностическая эффективность рекомендованных в руководстве порогов NT-proBNP для подгрупп пациентов: положительная прогностическая ценность возрастных порогов для подгрупп пациентов (450, 900 и 1800 пг/мл для <50, 50-75 и >75 лет соответственно). Diagnostic kuita kwegwara-inokurudzirwa NT-proBNP zvikumbaridzo zvevarwere subgroups: yakanaka yekufungidzira kukosha kwezera-yakananga zvikumbaridzo zvevarwere subgroups (450, 900, uye 1800 pg/mL ye <50, 50-75, uye> 75 makore, zvichiteerana) .指南 推荐 的 跨患者 跨患者 跨患者 的 NT-Probnp 阈值 的 诊断 性能: 跨患者 亚组 的 年龄 特异性 的 阳性 阳性 (分别 阳性 阳性 (岁）.指南 推荐 的 的 跨患者 跨患者 NT-probnp 阈值 的 性能: 跨患者 亚组 的 年龄 特异性 的 (分别 为 为 450 550 pg / ml, <50,50-75 和> 75 岁). Диагностическая эффективность порогов NT-proBNP, рекомендованных руководством, для подгрупп пациентов: положительная прогностическая ценность возрастных порогов для подгрупп пациентов (450, 900 и 1800 пг/мл, <50, 50-75 и >75 соответственно возрасту) . Diagnostic kuita kwegwara-yakakurudzirwa NT-proBNP zvikumbaridzo zvevarwere subgroups: yakanaka yekufungidzira kukosha kwezera-yakananga maburi evarwere subgroups (450, 900, uye 1800 pg/mL, <50, 50-75, uye> 75, zvichiteerana nezera. ) .COPD = chirwere chisingaperi chinodzivirira pulmonary;eGFR = inofungidzirwa glomerular filtration rate
Izvo zvakabatanidzwa meta-efungidziro yezvakanaka zvekufungidzira kukosha kwezera rekucheka-kubvisa kweNT-proBNP 450, 900, uye 1800 pg/mL mutemo yaive 61.0% (55.3% kusvika 66.4%), 73.5% (62.3% kusvika 82 . 3%) uye 80.2%, maererano (70.9% kusvika 87.1%) (Tafura 2).Izvo zvinoenderana ne87.8% (79.5% kusvika 93.0%), 81.1% (72.6% kusvika 87.5%), uye 73.1% (65.2% kusvika 79. masere%).Pakazara, 48.7% (5052/10,369) yevarwere vane fungidziro yekutadza kwemoyo wakanyanya vaive neNT-proBNP pamusoro pezvikumbaridzo zvezera.Pasinei nehterogeneity mumapoka ezera, kushanda kwetsvo, uye kuwanda kwekutadza kwemoyo kwakanyanya, mukati memapoka madiki, zera rekucheka-kwemitemo raive nehunhu hwakanaka hwekufungidzira pamusoro pekuchekwa kwe300 pg/mL (Supplementary Figure EI) .
Diagnostic kuita kweN-terminal B-mhando natriuretic peptide precursor (NT-proBNP) zera rekutanga kwekutadza kwemoyo kwakanyanya.
Pakazara, takaona zvidzidzo zvinomwe panjodzi huru yekusarura (Supplementary Table A).Mukuongorora kwekunzwa kunogumira kuzvidzidzo zvakapofumadzwa kuNT-proBNP kutariswa kwekutonga kwekutadza kwemoyo kwakanyanya uye zvidzidzo zvine njodzi yakaderera yekusarura, nhungamiro 'inokurudzirwa yekuongorora maitiro uye zera rekucheka kweNT-proBNP yakaramba isina kuchinjika (Supplementary Tables E uye F. ).
Iyo 100 pg/mL NT-proBNP pachikumbaridzo yakasangana neyedu yemhando yepamusoro nzira yekusarudzika neyakasanganiswa isina kunaka yekufungidzira kukosha kwe97.8% (rengere 95.8% kusvika 98.8%) uye kunzwa kwe99.3% (kurenji 98.5% kusvika 99.7%) (Supplementary Tafura D) .Zvisinei, chete 17.9% (1851/10 ~ 369) yevarwere vaiva neNT-proBNP yakadzika pasi pe100 pg / mL, uye vakanga vasina kunaka kune vakwegura nevarwere vane mwoyo wekushaya simba, coronary artery disease, uye nhoroondo yekusagadzikana Kufanotaura kunoramba kusina kunaka. ..Kushanda kweitsvo (Supplementary Figure J).Saizvozvo, iyo 1000 pg/mL NT-proBNP yakagurwa yakasangana neyedu yekuongorora nzira ine yakanaka yekufungidzira kukosha kwe74.9% (64.4% kusvika 83.2%) uye chaiyo ye76.1% (65.6% kusvika 84.2%).yakanga yakaderera.Musiyano.Yakanga yakadererawo mumapoka evarwere, kunyanya avo vasina nhoroondo yekare yekushaya simba kwemoyo (positive predictive value 62%, 41% kusvika 79%) (Supplementary Table D; Supplementary Figure K).
Iyo yakanyanyisa gradient inosimudzira (XGBoost) modhi uye yakajairika mutsara yakasanganiswa modhi yaive yakanakisa kuita mhando (nzvimbo iri pasi pe curve mune yakazara kudzidziswa cohort 0.925 (95% CI 0.919 kusvika 0.932) uye 0.931 (0.925 kusvika 0.937), zvichiteerana) Chinyorwa 2).Kunyangwe kuita kweXGBoost kwakafanana neyakajairwa mutsara wakasanganiswa modhi, yakakosha mukana weXGBoost kugona kwayo kuverenga zvibodzwa kana paine hunhu husipo.Ichi chinhu chakakosha chatinotarisira kushandisa muCoDE-HF sarudzo yekutsigira chishandiso kuti ifambise kuita kwayo mukuita kwekiriniki, ndosaka takasarudza iyo XGBoost modhi seyekupedzisira modhi yeCoDE-HF.
CoDE-HF yakanyatsogadziriswa uye yaive nerusarura rwakanyanya kune varwere vane uye vasina kutadza kwemoyo (nzvimbo iri pasi peanogamuchira anoshanda curve 0.846 (0.830 kusvika 0.862) uye 0.925 (0.919 kusvika 0.932) uye Brier mamakisi e0.130 uye 0.130, zvakateerana).0.099) (Mufananidzo 4; Supplementary Fig. L).Chiyero cheCoDE-HF che4.7 chinopa chirevo chisina kunaka che98.6% (97.8% kusvika 99.1%) uye kunzwa kwe98.1% (96.9% kusvika 98.9%) (Supplementary Table G) , uye chikamu che51.2 chinopa fungidziro yakanaka. value.kukosha 75.0% (65.7%) 82.5%), chaiyo yaiva 92.2% (87.5% kusvika 95.2%) yevarwere vasina nhoroondo yekushaya mwoyo.Izvi zvinosanganisirwa uye kuregererwa mazinga aive nekuita kwakafanana kwekuongorora muzvikamu zvese (Mufananidzo 5, Mufananidzo 6, Mufananidzo 7). Kana zvibodzwa izvi zvaishandiswa muvarwere vane fungidziro yekutadza kusimba kwemoyo, CoDE-HF yaizoratidza 40.3% (2502/6208) pamwepo yakaderera (<4.7) uye 28.0% (1737/6208) pamwepo mukuru (≥51.2) we acute heart failure. Kana zvibodzwa izvi zvaishandiswa muvarwere vane fungidziro yekutadza kusimba kwemoyo, CoDE-HF yaizoratidza 40.3% (2502/6208) pamwepo yakaderera (<4.7) uye 28.0% (1737/6208) pamwepo mukuru (≥51.2) we acute heart failure. Если бы эти показатели применялись к пациентам с подозрением на острую сердечную недостаточность, CoDE-HF выявил бы 40,3% (2502/6208) при низкой вероятности (<4,7) и 28,0% (1737/6208) при высокой вероятности (≥51,2) сердечной недостаточности. Kana mazinga aya aishandiswa kune varwere vaifungidzirwa kuti vakaoma mwoyo, CoDE-HF yaizoona 40.3% (2502/6208) ine mukana wakaderera (<4.7) uye 28.0% (1737/6208) ine mukana mukuru (≥51.2) mwoyo kukundikana.acute heart failure.如果 将 这些 评分 评分 疑似 急性 急性 急性 心力 心力 患者, Code-Hf 将 识别 出 40.3% (2502/6208) 的 (<4.7% (1737/6208) 急性 高概率 (≥51.2)衰竭.如果 将 这些 评分 应用 急性 急性 急性 衰竭 衰竭 ,,, Code-Hf 识别 出 出 40.3% (2502/6208) 的 低概率 低概率 (<4.7)】 28.0% (1737/6208) ) 急性 心力 急性 急性 急性 急性 急性 急性 急性 急性 急性 . Если бы эти оценки применялись к пациентам с подозрением на острую сердечную недостаточность, CoDE-HF выявил бы 40,3% (2502/6208) низкой вероятности (<4,7) и 28,0% (1737/6208) высокой вероятности (≥ 51, 2) острой сердечной недостаточности. Kana izvi zvibodzwa zvakashandiswa kune varwere vane fungidziro yekutadza kwemoyo, CoDE-HF yaizoratidza 40.3% (2502/6208) yakaderera mukana (<4.7) uye 28.0% (1737/6208) mukana wepamusoro (≥ 51.2) kutadza kwemoyo kwakanyanya.kupera simba.Pakati pevarwere vane pre-eposting heart failure, hapana kana chimwe chezvibodzwa muchikwata chekudzidzira chakasangana nemaitiro edu ekusabvisa.Iyo CoDE-HF mamakisi yaive 84.5, iyo yakanaka yekufungidzira kukosha yaive 92.7% (89.1% kusvika 95.2%), uye chaiyo yaive 90.2% (84.0% kusvika 94.1%).Kuongorora uku kucharatidza 45.5% (1420 / 3119) yevarwere vane mikana yakawanda yekuvandudza kukanganisa kwemoyo (Fig. 8).Mukuongorora curve yesarudzo pane zvese zvingangoitika pachikumbaridzo, CoDE-HF yaive nepamusoro mambure kuwana kupfuura NT-proBNP chete (Yekuwedzera Mufananidzo M).Nhamba dzeCoDE-HF dzakaderedzwa zvishoma pasina nhoroondo yekudzidziswa (nzvimbo iri pasi pemugamuchiri wekushanda curve yaiva 0.922 (0.916 kusvika 0.929) uye 0.841 (0.825 kusvika 0.825 kune varwere vasina kuparara kwemoyo uye pre-heart failure) 0.857).Mukati nekunze kwemuchinjiko-kusimbiswa kwakaitwa zvakanaka muchikwata chemhando mbiri (Supplementary Figure N).
The Heart Failure Joint Diagnosis uye Evaluation Scale (CoDE-HF) yakaenzaniswa kune yakaonekwa chikamu chevarwere vane acute heart failure.Mutsetse une madota unoratidza kuenzana kwakakodzera.Imwe neimwe pfungwa inoenderana ne100 varwere.Pamusoro: CoDE-HF calibration mumurwere asina kutadza kwemoyo.Pazasi: CoDE-HF calibration mumurwere ane nhoroondo yekutadza kwemoyo.
Kuongororwa kwekuita kweMwoyo Kukundikana Kubatanidzwa Kuongorora uye Kuongorora Chikero (CoDE-HF) mumapoka evarwere.Iyo CoDE-HF yekusasiya mamakisi yaive neakaipa yekufungidzira kukosha kwe4.7 muchikamu chevarwere vasina nhoroondo yekutadza kwemoyo.CoDE-HF inoshandisa N-terminal natriuretic peptide type B precursor concentrations sezviyero zvinoenderera uye zvakafanotsanangurwa zviri nyore zvinangwa zvekiriniki zvinosiyana (zera, inofungidzirwa glomerular filtration rate (eGFR), hemoglobin, body mass index, kurova kwemoyo, BP, peripheral edema, chisingaperi chinodzivirira. chirwere chepulmonary (COPD) uye chirwere chemoyo chemoyo) chinopa kuongororwa kwega kwega kwemukana wekuongororwa kweacute heart failure.
Diagnostic kuita kweCoDE-HF chiyero paKubatana kweKuongorora uye Kuongorora Kwemoyo Kutadza chiyero mumapoka evarwere.Nhamba yekutonga yeCoDE-HF yakanga ine hutano hwakanaka hwekufungidzira hwe51.2 muboka revarwere vasina nhoroondo yekushaya mwoyo.CoDE-HF yakabatanidza NT-proBNP kutariswa sezviyero zvinoenderera uye zvakafanotsanangurwa zviri nyore chinangwa chekiriniki zvinosiyana (zera, inofungidzirwa glomerular filtration rate (eGFR), hemoglobin, body mass index, kurova kwemoyo, BP, peripheral edema, chronic obstructive pulmonary disease (COPD) )coronary artery disease) inopa ongororo yega yega mukana wekuongororwa kweacute moyo kutadza
Diagnostic kuita kweKubatana kweKuongorora uye Kuongorora Kwemoyo Kutadza (CoDE-HF) chiyero mumapoka evarwere.Nhamba yekutonga yeCoDE-HF yakanga ine hutano hwakanaka hwekufungidzira hwe84.5 kune varwere vane nhoroondo yekushaya mwoyo muboka revarwere.CoDE-HF yakabatanidza NT-proBNP kutariswa sezviyero zvinoenderera uye zvakafanotsanangurwa zviri nyore chinangwa chekiriniki zvinosiyana (zera, inofungidzirwa glomerular filtration rate (eGFR), hemoglobin, body mass index, kurova kwemoyo, BP, peripheral edema, chronic obstructive pulmonary disease (COPD) )coronary artery disease) inopa ongororo yega yega mukana wekuongororwa kweacute moyo kutadza
Iyo Heart Failure Joint Diagnosis uye Assessment Scale (CoDE-HF) haina diagnostically inoshanda kune varwere vane nhoroondo yekutadza kwemoyo.Pamusoro: Zvakaipa uye zvakanaka zvekufungidzira kukosha zveCoDE-HF zvibodzwa.Mutsetse webhuruu wakatwasuka une doti unoratidza chinangwa chekubvisa chibodzwa che4.7.Mutsetse mutsvuku wakatwasuka wakamira unoratidza chinangwa chemutemo chibodzwa che51.2.Pazasi: density mepu yeCoDE-HF zvibodzwa muvarwere vasina nhoroondo yekutadza kwemoyo.Kusabatanidzwa uye zvinangwa zvekutonga zvakaonekwa 40.3% yevarwere vane mikana yakaderera uye 28.0% ine mikana yakawanda, maererano.
Varwere vakaonekwa sevashoma-mukana neCoDE-HF vaive vakaderera zvakanyanya-zvikonzero zvese uye kufa kweCV pamazuva makumi matatu uye 1 gore pane varwere vakaonekwa sepakati uye zvakanyanya-mukana (30-mazuva ese-chikonzero kufa: 1. 0% ichienzaniswa ne4.0 % uye 10.4%).kufa kubva kune zvikonzero zvose mukati megore rimwe: 5.9% inopesana ne17.8% uye 33.4%, maererano;Kufa kwemazuva makumi matatu kubva kune zvirwere zvemwoyo: 0.2% vs. 0.8% uye 4.1%;kufa kwegore negore kubva kune zvirwere zvemwoyo: 1.4% inopesana ne3.4% uye 16.3%, maererano) (Fig. 9). Muvarwere vane NT-proBNP concentrations <300 pg/mL zvichienzaniswa neavo ≥300 pg/mL, zvikonzero zvese zvekufa kwehuwandu hwaive 0.8% maringe ne7.6% pamazuva makumi matatu uye 5.9% maringe ne26.6% pagore rimwe chete, uye mwero wekufa kwemoyo wemoyo waiva 0.1% maringe ne2.6% pamazuva makumi matatu uye 1.3% maringe ne10.2% pagore rimwechete, zvichiteerana (yekuwedzera tafura H; yekuwedzera nhamba O). Muvarwere vane NT-proBNP concentrations <300 pg/mL zvichienzaniswa neavo ≥300 pg/mL, zvikonzero zvese zvekufa kwehuwandu hwaive 0.8% maringe ne7.6% pamazuva makumi matatu uye 5.9% maringe ne26.6% pagore rimwe chete, uye mwero wekufa kwemoyo wemoyo waiva 0.1% maringe ne2.6% pamazuva makumi matatu uye 1.3% maringe ne10.2% pagore rimwechete, zvichiteerana (yekuwedzera tafura H; yekuwedzera nhamba O). У пациентов с концентрацией NT-proBNP <300 пг/мл по сравнению с таковой ниже 300 пг/мл смертность от всех причин составила 0,6 , 3 % 5, 7 6% через один год, соответственно, и показатели смертности от сердечно-сосудистых заболеваний составили 0,1% по сравнению с 2,6% через 30 дней и 1,3% по сравнению с 10,2% через один год соответственно (дополнительная таблица H; дополнительный рисунок O). Muvarwere vane NT-proBNP concentration <300 pg/ml zvichienzaniswa neiyo iri pasi pe300 pg/ml, kufa kwezvikonzero zvese kwaive 0.8% zvichienzaniswa ne7.6% pamazuva makumi matatu uye 5.9% zvichienzaniswa ne26, 6% pagore rimwe, zvichiteerana. , uye huwandu hwekufa kweCV hwaive 0.1% zvichienderana ne2.6% pamazuva makumi matatu uye 1.3% inopesana ne10.2% pagore rimwe chete, maererano (Supplementary Table H; Supplementary Figure O). NT-proBNP 浓度<300 pg/mL 的患者与≥300 pg/mL 的患者相比，30 天全因死亡率分别为0.8% 和者与≥300 pg/mL 的患者相比，30 天全因死亡率分别为0.8% 和者别为0.8% 和者别为0.8% 和刴无 6 者% 和约% 6，一死亡率在30 天时分别為0.1% 和2.6%，一年时分别為1.3% 和10.2%（补充表H；补充图O）. NT-PROBNP 浓度 <300 pg/ml 的 与 ≥ ≥300 pg/ml 的 相比 ， 30 天全 因 分别 为 為 為 0.8% ne 7.6% . . .血管 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及 以及）. Пациенты с концентрацией NT-proBNP <300 пг/мл по сравнению с ≥300 пг/мл имели 30-дневную смертность от всех причин 0, 6%, 6%, 6%, 6%, 6% года, а также сердечно-сосудистую смертность. Varwere vane NT-proBNP concentrations <300 pg/mL vachienzaniswa ne ≥300 pg/mL vaiva nemazuva makumi matatu ekufa kwe0.8% uye 7.6%, maererano, 5.9% uye 26.6% mukati megore rimwe chete, uye kufa kwemwoyo.vaiva 0.1% uye 2.6% pamazuva 30 uye 1.3% uye 10.2% pa1 gore (Supplementary Table H; Supplementary Figure O).
Kuwedzera-kukonzeresa kufa kwehuwandu hwakarongwa neKubatanidzwa kweKuongorora uye Kuongorora kweKutadza Kwemoyo (CoDE-HF) mukana weboka
Takaita meta-analysis yemunhu mumwe nomumwe-level data kuti tiongorore mashandiro ekuongorora kweNT-proBNP zvikumbaridzo mune vanopfuura 10 varwere vane fungidziro yekuti kutadza kwemoyo kwakanyanya kusanganisirwa mune gumi nemana zvidzidzo kubva kunyika gumi nenhatu dzatakagadzira nekushandisa tichishandisa NT-proBNP.proBNP sechishandiso chekutsigira sarudzo yekuyera kuenderera.Isu tinoshuma zvakati wandei zvakakosha zvakawanikwa.Chekutanga, gwara rinokurudzirwa kuti risasanganisire acute heart failure haisi yunifomu pamapoka madiki evarwere.3 Kunyange zvazvo ruzhinji rwevanhu uye mapoka maduku akati wandei, kusanganisira varwere vechidiki nevakadzi, vakaita zvakanaka, varwere vakura nevakadzi vaive nemaitiro akaderera ekufungidzira.Mune varwere vane kufutisa kana kutadza kwemoyo kusati kwaitika, mwero wenhema wakashata wakabva kune mumwe mugumi kusvika kune mumwe muzvishanu.Chechipiri, zvikumbaridzo zvakashongedzwa zera zvakazviratidza zvakanaka mukuongororwa kwekutadza kwemoyo kwakanyanya.Nekudaro, iyo yakanaka yekufungidzira kukosha yaive yakaderera muvarwere vadiki.Chechitatu, kunyange zvazvo yedu yakagadziridzwa NT-proBNP cut-offs ye 100 pg/mL kuti ibvise acute heart failure uye 1000 pg/mL kutonga paacute heart failure ine yakanakisa yakaipa uye yakanaka yekufungidzira kukosha muruzhinji, varwere vakura vari kutowedzera. .muvarwere vane acute heart failure.Pamberi pemoyo kutadza uye kufutisa.Pakupedzisira, takagadzira uye takasimbisa chishandiso chekutsigira sarudzo, iyo CoDE-HF mamakisi, ine yakanakisa diagnostic kuita mumapoka ese evarwere.Ichi chishandiso chetsigiro chesarudzo chakasabatanidzwa uye chakabvisa kutadza kwemoyo zvakanyanya nenzira kwayo kupfuura chero nzira uchishandisa chete NT-proBNP chikumbaridzo.
Sekuziva kwedu, ichi ndicho chidzidzo chikuru kusvika parizvino chekuongorora mashandiro eNT-proBNP mukutadza kwemoyo.Zvose zvakabatanidzwa zvidzidzo zvaive zvinotarisirwa uye kuongororwa kwekupedzisira kwakaitwa neboka revarapi vachishandisa ruzivo rwese rwuripo.Zvakakosha kuziva kuti kuwanikwa kwedheta pahutano hwemurwere mumwe nomumwe muhuwandu hwekudzidza huzhinji hunobvumira kuongororwa kwakavimbika kwekuita kwekuongorora kwezvose zvinobvira NT-proBNP zvikumbaridzo muzvikamu zviduku zvevarwere, pamwe chete nekuvandudzwa nekusimbiswa kwezviyero zvitsva zvekuongorora.
Nhungamiro zhinji dzenyika uye dzepasirese dzinokurudzira kushandisa NT-proBNP yekucheka-kubvisa kukosha kwe300 pg/mL kuti ibvise acute heart failure58 zvichibva pane dzakawanda zvidzidzo zvakapfuura344142 zvichitaura zvakaipa zvekufungidzira kukosha kwe98% panguva iyi yekucheka.kuongororwa kwekuita kwezvikamu zvakakosha zvevarwere hazvigone kuongororwa.Chidzidzo chedu chakanyoresa varwere vakapetwa katatu seyekare yekudzidza-level meta-analyses, 3 iyo yakaratidza yakaderera yakazara yakaipa yekufungidzira kukosha pakuchekwa kwe300 pg/mL ine yakabatanidzwa meta-yekufungidzira ye94.6%.Zvinotonyanya kukosha, iyo yakaipa yekufungidzira kukosha yaive yakaderera zvakanyanya muzvikamu zvakakosha zvakadai sevarwere vakura uye varwere vane moyo isati yavapo, coronary artery chirwere, uye kufutisa.Mukuwedzera, inenge 70% yevarwere vaiva neNT-proBNP yakanyanyisa pamusoro peiyo 300 pg/ml cut-off point, vachiratidza miganhu yekushandisa imwe chete yekucheka-kubvisa pakuita.Kunyange zvazvo iyo yakaderera cutoff ye100 pg / mL yakawana huwandu husina kunaka hwekufungidzira kukosha kwe98%, yakaita zvisina kunaka muboka rinokosha revarwere.Pamusoro pezvo, zera uye zvikumbaridzo zvakagadziridzwa zvekutadza kwemoyo zvakanyanya zvakaratidza huterogeneity pamapoka evarwere, kunyanya pakati peavo vasina nhoroondo yekutanga yekutadza kwemoyo.Iyi heterogeneity mukuita kwekuongorora ndeyekunyanya kunetseka sezera redu remurwere uye ine mamwe macomorbidities.Izvi zvinomutsa mubvunzo wekuti mazano emakiriniki anofanirwa kuramba achikurudzira kushandiswa kweyunifomu yekucheka-kubvisa apo NT-proBNP inobatwa nehuwandu hwezvipingamupinyi uye zvirwere.
Kuti tivandudze kubatsira kwekiriniki kweNT-proBNP, isu takagadzira uye nekunze yakasimbisa iyo CoDE-HF kuongororwa kwekiriniki sarudzo yekutsigira chishandiso.Ichi chibodzwa chinosanganisa NT-proBNP seyero inoenderera ine yakapusa chinangwa chekiriniki machinjiro kuti ape kuongororwa kwega kwega kwemukana wekuongororwa kweacute heart failure.Isu tinoratidza kuti kuongororwa kwekuita kweCoDE-HF mamakisi kwakasimba mumapoka evarwere.CoDE-HF yakakwanisa kubvisa uye kubvisa kuongororwa kweacute heart failure muchikamu chikuru chevarwere pane yakagadziridzwa NT-proBNP chikumbaridzo chete.Uyezve, mukuongorora kwedu curve yesarudzo, takaona kuti CoDE-HF ine bhenefiti yepamusoro kupfuura NT-proBNP chete, padanho rese remukana.Isu tinotenda kuti mhedziso iyi intuitive sezvo NT-proBNP inoramba ichimaka yenjodzi uye kutarisisa kwayo kunoenderana nezvimwe zvine chekuita nemurwere senge body mass index, zera, uye renal basa.434445 Kunyange zvazvo zviyero izvi zvichibva pane zvakafanotsanangurwa maitiro ekuita, tinoona kuti izvi zvinangwa zvinogona kunge zvisingatsigire pasi rose uye kuti nzvimbo dzehutano dzakasiyana dzinogona kuva nekushivirira kwakasiyana kwengozi.Chakanakira kushandisa maturusi ekutsigira sarudzo seCoDE-HF ndechekuti varapi kana masangano anogona kusarudza maitiro ekuongorora kuti ashandiswe pakuita sarudzo dzemunharaunda zvichibva pane zvavanokoshesa uye kuwanikwa kweechocardiography kana nyanzvi dzekutadza kwemoyo..
Isu tinotarisira kuti chishandiso chedu chitsva chekutsigira sarudzo, Code-HF, inogona kuvandudza kutariswa kwevarwere vane fungidziro yekutadza kwemoyo kunoonekwa mune akasiyana hunyanzvi hwekurapa uye kushandura kutarisira kwavo, kufambisa kuongororwa kwakaringana.Ongororo dzakapfuura dzakaratidza kuti panguva yakakodzera uye yakarurama humbowo-based treatment yevarwere vane acute heart failure inogona kuderedza zvakanyanya kufa uye kureba kwekugara muchipatara, uye kunonoka kunobatanidza nemigumisiro yakaipa.46 Pamusoro pezvo, inogara ichiunganidzwa CoDE-HF inoshandisa zvinoshanduka uye saka inogona kuisirwa mumakiriniki workflows sechikamu chedhipatimendi rekukurumidzira triage nzira yekugonesa kunyatsoita kuongororwa.Parizvino, ruzhinji rwevarwere vane fungidziro yekutadza kutadza kwemoyo vane echocardiography pakubvumidzwa kuti vaone kurapwa kwavo, asi chikamu chidiki chevarwere ndicho chinozoonekwa.2 Echocardiography inguva inopedza nguva uye ine zviwanikwa zvehunyanzvi kudzidza Isu tinotarisira kuti kushandiswa kweCoDE-HF kwechokwadi uye neruzivo rwekushandisa kwehunyanzvi masevhisi senge echocardiography kunogona kutungamira mukukosheswa kwemutengo uye kugona kwehutano hwehutano..Mukuwedzera, mari yekuchengetedza inogona kuwanikwa kuburikidza nekurapa kunze kwevarwere vane njodzi shoma.Chidzidzo chinotarisirwa chiri kudiwa pari zvino kuti uongorore kiriniki uye mutengo-unoshanda weakasiyana CoDE-HF sarudzo dzemakiriniki maitiro.
Tinobvuma ganhuriro dzinoverengeka.Kutanga, takakwanisa kuwana ruzivo rwemurwere mumwe nomumwe we14 yezvidzidzo zve30 zvakasangana nemaitiro edu ekukodzera, saka kusarudzwa kwekusarudza kunogona kuiswa.Zvisinei, zvidzidzo zvakakodzera izvo zvakanga zvisina kubatanidzwa zvakave nekupararira kwakafanana kwekushaya simba kwemoyo, mazuva ekubudiswa, uye kuvharidzirwa kwenzvimbo, uye vanhu vaiva nemhando dzakasiyana-siyana uye kliniki kune vanhu vakabatanidzwa.Chechipiri, apo ruzivo kubva kune dzakawanda zvidzidzo rwakabatanidzwa, zvimwe zvidzidzo zvakanga zvisipo data kune zvimwe zvakasiyana.Kuti tiwedzere kushandiswa kwemashoko, takashandisa nzira ye hierarchical yekunyengedza kwakawanda.Chechitatu, isu hatina kunyora ECG nechipfuva X-ray data sequentially kuti tizviise mumuenzaniso wedu.Tsanangudzo yeNT-proBNP muvarwere vane fungidziro yekuti kukundikana kwemoyo kunofanirwa kuitwa pamwe chete nezvidzidzo izvi, 47 uye zvimwe zvidzidzo zvinodiwa kuona kana nzira dzekubatanidza zvidzidzo izvi dzinogona kuvandudza zvibodzwa zveCoDE-HF.Chechina, hazvisi zvese zvidzidzo zvakaongororwa pasina kufunga nezvemhedzisiro yeNT-proBNP bvunzo.Mukuongorora kwedu kwekunzwa, patakabvisa zvidzidzo zviviri netsanangudzo isina kuvharwa, pakanga pasina shanduko mukuita kwekuongorora.Chechishanu, kuongororwa kwakagadziriswa kwekushaya mwoyo kwakanyanya hakuna kubvumira kusiyanisa pakati pekukundikana kwemoyo nekuderedzwa kwechikamu chejection uye kukanganisa kwemoyo nekuchengetedzwa kwejection fraction.48 Kuwanda kwekuwedzera kweHF nechikamu chejection chakachengetwa muvarwere vakwegura chinogona kutsanangura mamwe ehterogeneity akaonekwa nezera, asi mazano emazuva ano anokurudzira HF nechikamu chakaderedzwa ejection uye EF yakachengetedzwa.Kukundikana kwemoyo kunoshandisa zvakafanana NT-ProBNP chikumbaridzo.58 Chechitanhatu, kunyange zvazvo zvidzidzo zvakawanda zvakagara zvichinyora varwere vane acute dyspnoea, kuwanda kwekushaya mwoyo kwakanyanya kwakanga kwakakwirira uye kusarudzwa kwekusarudza kungave kuripo.Zvisinei, kushanda kwemitemo-yakakurudzirwa NT-proBNP kucheka-kubvisa uye miganhu yezera haina kuchinja mukunzwisisa kuongorora, kunze kwezvidzidzo zvine ngozi yakawanda yekusarura.Chekupedzisira, kutadza kwemoyo kwakanyanya chirwere chekiriniki, uye kuongororwa pachayo kune kusavimbika kwemukati uye kusiyanisa kwekutsvaga.Kusava nechokwadi uku kunogona kunge kwakakura kune vakwegura, izvo zvinogona kutsanangura chikamu chakacherechedza heterogeneity mumigumisiro yekuongorora.
Isu takaratidza kuti kuongororwa kwekuita kweiyo NT-proBNP yakachekwa-yakatarwa tsika inokurudzirwa mugwara reacute moyo kutadza kunosiyana muboka rakakosha revarwere.Isu takagadzira uye takasimbisa mucherechedzo weCoDE-HF, unobatanidza NT-pro-BNP seyero inoenderera nemakiriniki akasiyana-siyana kuti aone mukana wekutadza kwemoyo wakanyanya mumurwere wega wega achishandisa nhamba yemuenzaniso.Ichi chishandiso chetsigiro chesarudzo chakanyatso kutongerwa kunze uye chakabvisa acute moyo kutadza uye chaigara chichiitwa mumapoka madiki ese.Zvidzidzo zvinotarisirwa pari zvino zvinodiwa kuti zviongorore kukanganisa kwekushandisa iyi sarudzo yekutsigira chishandiso pamashandisirwo ezvehutano zvehutano nemhedzisiro yevarwere.
Kuongororwa kweacute heart failure kunogona kuve kwakaoma nekuti varwere vanowanzouya vasina zviratidzo.
Nhungamiro zhinji dzenyika nedzepasirese dzinokurudzira kuedza N-terminal B-type natriuretic peptide precursor (NT-proBNP) yekuongororwa kweacute heart failure.
NT-proBNP bvunzo haina kushandiswa pasi rose nekuda kwematambudziko nekuita kwekuongorora mumakiriniki akakosha mapoka evarwere.
Iyo yakakurudzirwa NT-proBNP zvikumbaridzo zveacute heart failure mumirayiridzo ine hurombo husina kunaka hwekuita muzvikamu zvakakosha zvevarwere.
Chishandiso chetsigiro chesarudzo chakasimbiswa chakagadzirwa icho chinobatanidza NT-pro-BNP seyero inoenderera nekuchinja kwekiriniki uchishandisa nhamba yekuenzanisa.
Ichi chishandiso chakanyatso kutongerwa kunze uye chakabvisa kutadza kwemoyo kwakanyanya kupfuura chero nzira uchishandisa iyo NT-proBNP chikumbaridzo chete uye yaiitwa nguva dzose mumapoka madiki ese.
Zvidzidzo zvose zvakaitwa maererano neDeclaration of Helsinki uye zvakabvumirwa netsika kuti zvibvumire kugoverana kwehuwandu hwehuwandu hwevarwere hwekuongorora uku.
Iyo R kodhi uye isingazivikanwe data rinoshandiswa kugadzira uye kusimbisa iyo CoDE-HF mamakisi inowanikwa kune vanoongorora nekukumbira kwemunyori.