视网膜血管特征预测先天性心脏病患者远期心血管事件的真实世界回顾性队列研究OA

Objective To investigate the predictive value of retinal vascular features(RVFs)for long-term major adverse cardiovascular events(MACE)in patients with congenital heart disease(CHD).Methods Clinical data were retrospectively collected from patients with CHD admitted to the Department of Congenital Heart Disease Surgery,Guangdong Provincial People's Hospital,who received systematic ophthalmic examinations between May 2017 and November 2022.A total of 147 CHD patients with available baseline fundus photographs and no history of MACE at baseline were enrolled in this study.An Elastic Net Cox regression model was applied to identify core RVFs while effectively controlling for multicollinearity,based on which a comprehensive RVFs score was constructed.Meanwhile,Ridge regression was used to aggregate multiple well-established clinical baseline charac-teristics into an integrated clinical risk score.The independent prognostic value and incremental predictive perfor-mance of the RVFs score for long-term MACE in CHD patients were comprehensively assessed via bivariate analysis,multivariable Cox regression,time-dependent receiver operating characteristic(ROC)curves,and the Kaplan-Meier method.Results After a median follow-up duration of 53.22 months,13 major adverse cardiovascular events(MACE,8.9%)occurred.The model identified 8 core RVFs in the final analysis.After full adjustment for aggre-gated clinical baseline risk factors,the RVFs-based score was confirmed to be an independent predictor of MACE[hazard ratio(HR)=3.92,95%confidence interval(CI):2.23-6.92,P<0.001],and the bivariate predictive model achieved a C-index of 0.83.When stratified by the optimal cut-off value of the RVFs score,patients in the high-risk group had a significantly higher cumulative incidence of MACE than those in the low-risk group(Log-rank P<0.001).Furthermore,incorporating the RVFs score improved 5-year MACE risk prediction:the area under the receiver operating characteristic curve(AUC)increased substantially from 0.62 for the clinical-only model to 0.92 for the combined model.Conclusions RVFs extracted from fundus photographs are independently associated with long-term MACE risk in patients with CHD.The RVFs-based risk score constructed in this study can effectively improve risk stratification performance,and holds promise as a non-invasive,easily accessible adjunctive tool for long-term cardiovascular risk assessment in this population.