Preoperative echocardiography-based nomogram for postoperative cardiac complications in pancreatic cancer with vascular invasion

doi:10.3748/wjg.120464

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Nov 7, 2026; 32(41): 120464
Published online Nov 7, 2026. doi: 10.3748/wjg.120464

Preoperative echocardiography-based nomogram for postoperative cardiac complications in pancreatic cancer with vascular invasion

Shan Jin, Fang-Fei Wang, Shao-Cheng Lyu, Xin Zhao, Qiang He, Xiu-Zhang Lyu

Shan Jin, Xiu-Zhang Lyu, Department of Echocardiography, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China

Fang-Fei Wang, Shao-Cheng Lyu, Xin Zhao, Qiang He, Division of Hepatobiliary and Pancreaticosplenic Surgery, Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China

Co-first authors: Shan Jin and Fang-Fei Wang.

Co-corresponding authors: Qiang He and Xiu-Zhang Lyu.

Author contributions: Jin S and Wang FF contributed to writing-original draft, they contributed equally to this manuscript and are co-first authors; Jin S, Wang FF, Lyu SC, and Zhao X contributed to investigation and data curation; Jin S, Wang FF, Lyu SC, and He Q contributed to project administration; He Q and Lyu XZ contributed to supervision, writing-review and editing, they contributed equally to this manuscript and are co-corresponding authors; and all authors have read and approved the final manuscript.

AI contribution statement: AI tool Kimi K2.6 (Moonshot AI) was used solely to assist with language translation and polishing. All data analysis, figure generation, and reference management were performed independently by the authors using standard scientific software. No AI was involved in data processing, image creation, or analytical decision-making. To ensure the accuracy and professionalism of our responses to the reviewers’ comments, we utilized an AI translation tool (Kimi 2.6) solely as an English-language assistant during the revision process. Specifically, we drafted all responses in Chinese based on our own experimental data, critical analysis, and scientific reasoning, and then used the AI tool to translate these original Chinese drafts into English. At no point was AI employed to directly generate the scientific content, interpretations, or arguments presented in our rebuttal. Every response reflects our independent intellectual contribution and thorough understanding of the research.

Institutional review board statement: This study was approved by the Ethics Committee of Beijing Chaoyang Hospital (Approval No. 2024-D-512). All procedures adhered to the ethical standards of the 1964 Helsinki Declaration.

Informed consent statement: All patients provided general informed consent for the use of their medical data for research purposes upon admission, as per hospital policy. Additional individual consent was waived by the Ethics Committee for this retrospective analysis involving anonymized data review.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: No additional data are available.

Corresponding author: Qiang He, MD, Division of Hepatobiliary and Pancreaticosplenic Surgery, Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing 100020, China. heqiang349@163.com

Received: February 27, 2026
Revised: April 9, 2026
Accepted: May 14, 2026
Published online: November 7, 2026
Processing time: 200 Days and 0.7 Hours

Abstract

BACKGROUND

Pancreatic cancer with vascular invasion requires complex surgery, which is associated with substantial perioperative cardiac risk. Existing risk stratification tools lack specificity for this population and do not incorporate quantitative echocardiographic parameters.

AIM

To develop a nomogram integrating preoperative cardiac biomarkers and echocardiography parameters for predicting major postoperative cardiac complications (MPCCs) in patients undergoing surgery for pancreatic cancer with vascular invasion.

METHODS

This retrospective cohort study included 138 consecutive patients who underwent surgery for pancreatic cancer with vascular invasion. Preoperative clinical data and transthoracic echocardiography parameters were collected. MPCCs (myocardial infarction, arrhythmia, acute heart failure, or cardiac death within 30 days) constituted the primary endpoint. Independent predictors were identified through multivariable logistic regression and incorporated into a nomogram. Model performance was assessed by discrimination (C-index), calibration (Hosmer-Lemeshow test), and clinical utility (decision curve analysis).

RESULTS

MPCCs occurred in 45 patients (32.6%). Multivariable analysis identified preoperative B-type natriuretic peptide [odds ratio (OR) = 1.037, 95% confidence interval (CI): 1.013-1.063], ratio of early mitral inflow velocity (E) to average early diastolic mitral annular velocity (e’) (average E/e′ ratio) (OR = 1.296, 95%CI: 1.044-1.610), and left atrial volume index (OR = 1.046, 95%CI: 1.017-1.076) as independent predictors. The nomogram demonstrated excellent discrimination (C-index: 0.874, 95%CI: 0.812-0.936) and good calibration (P = 0.392). Decision curve analysis confirmed positive net benefit across clinically relevant threshold probabilities.

CONCLUSION

A nomogram based on preoperative B-type natriuretic peptide, average E/e′ ratio, and left atrial volume index accurately predicts postoperative cardiac complications in pancreatic cancer patients with vascular invasion. This tool facilitates preoperative risk stratification and guides perioperative management decisions.

Keywords: Postoperative complications; Echocardiography; Left atrial volume index; B-type natriuretic peptide; Average E/e’ ratio

Core Tip: Pancreatic cancer with vascular invasion carries substantial perioperative cardiac risk. This study developed a novel nomogram integrating preoperative B-type natriuretic peptide, average E/e’ ratio (early mitral inflow velocity to average mitral annular early diastolic velocity ratio), and left atrial volume index to predict postoperative cardiac complications. The nomogram demonstrated excellent discrimination (C-index: 0.874) and calibration. This nomogram enables early identification of high-risk patients and facilitates tailored perioperative management strategies, advancing precision risk stratification in this vulnerable population.