目的:斑点追踪超声心动图(STE)评估妊娠高血压疾病(HDP)对左心房(LA)力学的影响研究甚少。因此,我们进行了荟萃分析,以总结测量LA储层(LASr)的STE研究的主要发现,HDP女性的导管(LAScd)和收缩(LASct)应变。
方法:所有超声心动图研究评估HDP女性的LA应变参数与健康的控制,从PubMed和EMBASE数据库中选择,包括在内。使用美国国立卫生研究院(NIH)病例对照研究质量评估评估偏倚的风险。连续数据(LASr,LAScd和LASct)合并为标准化平均差异(SMD),将HDP组与健康对照组进行比较。LASr的整体SMD,使用随机效应模型计算LAScd和LASct。
结果:分析了8项研究的全文,其中566名HDP妇女和420名健康孕妇。平均LASr(34.3±6.4vs42.7±5.3%,P=0.01)和LAScd(23.4±6.3vs32.5±6.0%,P<0.001)在HDP妇女中明显低于对照组,而LASct(-13.0±5.4vs-13.7±4.5%,两组妇女的P=0.18)相似。在评估LASr的研究中检测到显著的异质性(I2=94.3%),LAScd(I2=64.9%)和LASct(I2=86.4%)。LASr(-1.70,95CI-2.34,-1.06,P<0.001)和LAScd(-1.35,95CI-1.69,-1.00,P<0.001)的SMD较大且具有统计学意义,LASct(-0.11,95CI-0.60,0.39,P=0.678)评估较小,无统计学意义。Egger检验得出LASr的P值为0.10、0.34和0.75,分别测量LAScd和LASct,表明没有出版偏见。在荟萃回归分析中,没有一个调节因子与LASr及其组分的效应改变显著相关(均P<0.05)。
结论:HDP与妊娠期LASr损伤独立相关。STE允许识别,在HDP女性中,那些可能从更积极的抗高血压治疗和/或更密切的临床随访中受益的人,旨在降低不良孕产妇结局和以后生活中心血管并发症的风险。
OBJECTIVE: The influence of hypertensive disorders of pregnancy (HDP) on left atrial (LA) mechanics assessed by speckle tracking echocardiography (STE) has been poorly investigated. Accordingly, we performed a meta-analysis to summarize the main findings of STE studies who measured LA reservoir (LASr), conduit (LAScd) and contractile (LASct) strain in HDP women.
METHODS: All echocardiographic studies assessing LA strain parameters in HDP women vs. healthy controls, selected from PubMed and EMBASE databases, were included. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment of Case-Control Studies. Continuous data (LASr, LAScd and LASct) were pooled as standardized mean difference (SMD) comparing HDP group with healthy controls. The overall SMDs of LASr, LAScd and LASct were calculated using the random-effect model.
RESULTS: The full-texts of 8 studies with 566 HDP women and 420 healthy pregnant women were analyzed. Average LASr (34.3 ± 6.4 vs 42.7 ± 5.3 %, P = 0.01) and LAScd (23.4 ± 6.3 vs 32.5 ± 6.0 %, P < 0.001) were significantly lower in HDP women than controls, whereas LASct (-13.0 ± 5.4 vs -13.7 ± 4.5 %, P = 0.18) was similar in the two groups of women. Substantial heterogeneity was detected among the studies evaluating LASr (I2 = 94.3 %), LAScd (I2 = 64.9 %) and LASct (I2 = 86.4 %). SMDs were large and statistically significant for LASr (-1.70, 95 %CI -2.34,-1.06, P < 0.001) and LAScd (-1.35, 95 %CI -1.69,-1.00, P < 0.001), small and not statistically significant for LASct (-0.11, 95 %CI -0.60,0.39, P = 0.678) assessment. Egger\'s test gave P-values of 0.10, 0.34 and 0.75 for LASr, LAScd and LASct measurement respectively, indicating no publication bias. On meta-regression analysis, none of the moderators was significantly associated with effect modification for LASr and its components (all P < 0.05).
CONCLUSIONS: HDPs are independently associated with LASr impairment in pregnancy. STE allows to identify, among HDP women, those who might benefit from a more aggressive antihypertensive treatment and/or a closer clinical follow-up, aimed at reducing the risk of adverse maternal outcome and cardiovascular complications later in life.