Echocardiography-based predictive model for cardiovascular risk for patients with elevated blood pressure

ZHAO Wen-lang; SUN Jia-yi; QI Yue; HAO Yong-chen; YANG Zhao; WANG Ming-dan; ZHOU Pan; WANG Na; WANG Zi-yu; LIU Jun; LIU Jing

doi:10.3969/j.issn.1672-5301.2025.06.011

Abstract：Objective To develop a predictive model for cardiovascular risk in individuals with elevated blood pressure by integrating traditional risk factors with echocardiographic parameters and to evaluate its predictive performance.Methods Base on survey data from 5310 participants in Beijing of the Multi-provincial Cohort for Hypertension(MUCH),2358 patients with elevated blood pressure(systolic blood pressure≥ 130 mmHg,diastolic blood pressure≥80 mmHg,or diagnosed hypertension)who had undergone echocardiographic examinations and free of cardiovascular disease were enrolled and followed up for 6 years.Baseline data collection was conducted from 2017 to 2020,and follow-up was performed through external data linkage and phone interviews.The latest follow-up was completed by December 31,2023.The predictive ability of three models,i.e.,the integrated model incorporating traditional risk factors with echocardiographic features,simplified integrated model incorporating traditional risk factors with guideline-recommended echocardiographic features and a traditional predictive model were compared.Model discrimination capacity was assessed using the C-index;calibration capacity was evaluated through the calibration intercept and slope;and reclassification capacity was quantified by the net reclassification index and the integrated discrimination improvement.Results During the six-year follow-up,93 cardiovascular events occurred.The C-index of the traditional risk model was 0.732(95％CI 0.682-0.775),while the simple echocardiographic model had a C-index of 0.685(95％CI 0.637-0.737).The integrated model and simplified integrated model showed a C-index of 0.741(95％CI 0.699-0.780)and 0.734(95％CI 0.690-0.777),respectively.Compared to the traditional model,the net reclassification index of the echocardiographic-only model was-0.005(95％CI 0.161-0.150),while the net reclassification index of the integrated model and simplified integrated model were 0.128(95％CI 0.005-0.251)and 0.052(95％CI 0.027-0.132),respectively.Conclusion Echocardiographic indices can further enhance the predictive ability of traditional risk assessment models.The proposed integrated model demonstrates good discriminatory power in predicting future cardiovascular disease risk among individuals with elevated blood pressure.