Chin et al reported a model for midwall myocardial fibrosis in patients with aortic stenosis. This fibrosis is a marker of early ventricular decompensation and adverse outcomes in patients with aortic stenosis. The authors are from the Univeristy of Edinburgh, National Heart Center Singapore, Bichat Hospital (Paris) and Tenon Hospital (Paris).
Patient selection: aortic stenosis
Parameters:
(1) age in years
(2) sex
(3) Vmax in meters per second
(4) high sensitivity troponin I concentration in ng/L
(5) strain pattern on ECG
Parameter
Finding
Points
age in years
0.047 * (years)
sex
female
0
male
1.356
Vmax
2.319 * LN(Vmax)
troponin I
0.935 * LOG10(troponin)
ECG strain
no
0
yes
3.616
value of X =
= SUM(points for all 5 parameters) - 9.387
probability of midwall fibrosis =
= 1 / (1 + EXP((-1)*X))
Interpretation:
• A probability less than 7% is considered low probability.
• A probability over 57% is considered high probability.
• A probability of 7 to 57% is intermediate probability.
Probability
5-Year Cardiovascular Mortality
5-Year All-Cause Mortality
low
0%
0%
intermediate
13%
23%
high
59%
63%
Performance:
• The area under the ROC curve is 0.85.
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