基于深度学习的视网膜生物标志物（Reti-CVD）在心血管疾病预测中的验证：来自英国生物库的数据。
Validation of a deep-learning-based retinal biomarker (Reti-CVD) in the prediction of cardiovascular disease: data from UK Biobank.
机构信息
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
Duke-NUS Medical School, Singapore, Singapore.
出版信息
BMC Med. 2023 Jan 24;21(1):28. doi: 10.1186/s12916-022-02684-8.
BACKGROUND
Currently in the United Kingdom, cardiovascular disease (CVD) risk assessment is based on the QRISK3 score, in which 10% 10-year CVD risk indicates clinical intervention. However, this benchmark has limited efficacy in clinical practice and the need for a more simple, non-invasive risk stratification tool is necessary. Retinal photography is becoming increasingly acceptable as a non-invasive imaging tool for CVD. Previously, we developed a novel CVD risk stratification system based on retinal photographs predicting future CVD risk. This study aims to further validate our biomarker, Reti-CVD, (1) to detect risk group of ≥ 10% in 10-year CVD risk and (2) enhance risk assessment in individuals with QRISK3 of 7.5-10% (termed as borderline-QRISK3 group) using the UK Biobank.
METHODS
Reti-CVD scores were calculated and stratified into three risk groups based on optimized cut-off values from the UK Biobank. We used Cox proportional-hazards models to evaluate the ability of Reti-CVD to predict CVD events in the general population. C-statistics was used to assess the prognostic value of adding Reti-CVD to QRISK3 in borderline-QRISK3 group and three vulnerable subgroups.
RESULTS
Among 48,260 participants with no history of CVD, 6.3% had CVD events during the 11-year follow-up. Reti-CVD was associated with an increased risk of CVD (adjusted hazard ratio [HR] 1.41; 95% confidence interval [CI], 1.30-1.52) with a 13.1% (95% CI, 11.7-14.6%) 10-year CVD risk in Reti-CVD-high-risk group. The 10-year CVD risk of the borderline-QRISK3 group was greater than 10% in Reti-CVD-high-risk group (11.5% in non-statin cohort [n = 45,473], 11.5% in stage 1 hypertension cohort [n = 11,966], and 14.2% in middle-aged cohort [n = 38,941]). C statistics increased by 0.014 (0.010-0.017) in non-statin cohort, 0.013 (0.007-0.019) in stage 1 hypertension cohort, and 0.023 (0.018-0.029) in middle-aged cohort for CVD event prediction after adding Reti-CVD to QRISK3.
CONCLUSIONS
Reti-CVD has the potential to identify individuals with ≥ 10% 10-year CVD risk who are likely to benefit from earlier preventative CVD interventions. For borderline-QRISK3 individuals with 10-year CVD risk between 7.5 and 10%, Reti-CVD could be used as a risk enhancer tool to help improve discernment accuracy, especially in adult groups that may be pre-disposed to CVD.
背景
目前在英国，心血管疾病（CVD）风险评估基于 QRISK3 评分，其中 10%的 10 年 CVD 风险表示临床干预。然而，这种基准在临床实践中的效果有限，因此需要一种更简单、非侵入性的风险分层工具。视网膜摄影术作为一种非侵入性的 CVD 成像工具，越来越被人们接受。此前，我们开发了一种基于预测未来 CVD 风险的视网膜照片的新型 CVD 风险分层系统。本研究旨在进一步验证我们的生物标志物 Reti-CVD：（1）在 QRISK3 为 7.5-10%（称为边缘 QRISK3 组）的个体中，检测 10 年 CVD 风险≥10%的风险组；（2）使用英国生物库增强风险评估。
方法
计算 Reti-CVD 评分，并根据英国生物库的优化截断值将其分层为三个风险组。我们使用 Cox 比例风险模型评估 Reti-CVD 在普通人群中预测 CVD 事件的能力。C 统计量用于评估在边缘 QRISK3 组和三个脆弱亚组中添加 Reti-CVD 对 QRISK3 的预后价值。
结果
在 48260 名无 CVD 病史的参与者中，11 年随访期间有 6.3%发生 CVD 事件。Reti-CVD 与 CVD 风险增加相关（调整后的危险比[HR] 1.41；95%置信区间[CI]，1.30-1.52），Reti-CVD 高风险组的 10 年 CVD 风险为 13.1%（95%CI，11.7-14.6%）。在 Reti-CVD 高风险组中，边缘 QRISK3 组的 10 年 CVD 风险超过 10%（非他汀类药物队列[非他汀类药物队列的 n=45473]为 11.5%，1 期高血压队列[n=11966]为 11.5%，中年队列[n=38941]为 14.2%）。在非他汀类药物队列中，C 统计量增加了 0.014（0.010-0.017），在 1 期高血压队列中增加了 0.013（0.007-0.019），在中年队列中增加了 0.023（0.018-0.029），用于预测 CVD 事件。
结论
Reti-CVD 有可能识别出≥10%的 10 年 CVD 风险人群，这些人群可能受益于更早的预防性 CVD 干预。对于 QRISK3 为 7.5-10%、10 年 CVD 风险在 10%之间的边缘 QRISK3 个体，Reti-CVD 可作为风险增强工具，有助于提高辨别准确性，尤其是在可能易患 CVD 的成年人群中。
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