Branched-chain Amino Acid Metabolites for Prediction of Low Cardiac Output after External Circulation of Rheumatic Heart Valve Disease
Objective:To investigate the predictive value of branched-chain amino acid metabolites in low cardiac output events after cardiopulmonary bypass in rheumatic valvular heart disease patients.Methods:A total of 154 patients with rheumatic valvular heart disease were selected as the study objects.According to whether low cardiac output occurred after cardiopulmonary bypass,the patients were divided into a low cardiac output group(52 cases)and a non-low cardiac output group(102 cases).The two groups of patients were compared and analyzed,and the important influencing factors of low cardiac output events were analyzed by multivariate Logistic regression.Cox proportional risk model was used to analyze the association of branched-chain amino acid metabolites and traditional markers with low cardiac output events.The GRACE risk score was used to investigate the predictive ability of branched-chain amino acid metabolites combined with traditional markers for low cardiac output.Cox regression was used to evaluate the interaction between branched-chain amino acid metabolites and traditional markers.The prediction model of regression equation y=1-1/(1+e-z)was established and verified.Results:Brain natriuretic peptide precursors,troponin I,leucine,valine,and isoleucine were independent risk factors related low cardiac output events.As the levels of brain natriuretic peptide precursors,troponin I,leucine,valine,isoleucine increased,the association with low cardiac output events became stronger.The combination of branched-chain amino acids and traditional markers could improve the ability of GRACE risk score to predict low cardiac output.Isoleucine combined with brain natriuretic peptide precursors showed the highest predictive effect for low cardiac output events.Through Bootstrap self-sampling,the prediction model showed good differentiation and accuracy.Conclusion:Branched-chain amino acid metabolites are closely associated with low cardiac output.The addition of branched-chain amino acid metabolites to traditional markers will improve the predictive ability of low cardiac output and help improve the prognosis of rheumatic valvular heart disease patients.
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