背景:整体纵向应变(GLS)受损的存在可能是早期诊断左心室(LV)损害的有价值的生物标志物,这将有助于仔细检查无症状主动脉瓣狭窄(AS)患者的高风险的不良结局,如主要不良心血管事件(MACE)。
方法:该研究在PROPSERO(CRD42021223472)进行了前瞻性登记。数据库,如Pubmed,Embase,科克伦图书馆,WebofScience,搜索了Scopus评估GLS受损对MACE影响的研究,全因死亡率,无症状AS的主动脉瓣置换术(AVR)。用二元变异的荟萃分析计算95%CI的危险比(HR)。元回归,亚组分析,并根据需要应用敏感性分析来探索异质性。
结果:最终,共纳入9项报告1,512例患者的研究.与正常GLS组相比,受损的GLS显着增加MACE(HR=1.20,95%CI:1.10-1.30,I2=79%),具有明显的异质性,全因死亡率(HR=1.42,95%CI:1.24-1.63),和AVR(HR=1.17,95%CI:1.07-1.28)。按左心室射血分数(LVEF)>50%或LVEF无精确切点分层的亚组分析发现,与正常GLS组相比,受损的GLS在两个亚组中均显着增加了MACE(LVEF>50%:HR:1.22,95%CI:1.05-1.50;LVEF无切点:HR:1.25,95%CI:1.05-1.50)。按AS严重程度(轻度/中度和重度)或随访时间分层的结果类似于按LVEF分层的结果。此外,当通过平均主动脉瓣压力梯度(MG≥40mmHg和MG<40mmHg)对亚组分析进行分层时,与正常GLS相比,受损的GLS在两个亚组中均显着增加了MACE(MG≥40mmHg:HR:3.41,95%CI:1.64-7.09;MG低于40mmHg:HR:3.17,95%CI:1.87-5.38)。此外,此处的效应大小大大高于前两个分层因素中的效应大小。
结论:无论LVEF或AS严重程度或随访时间或主动脉瓣平均压力梯度如何,无症状AS患者GLS受损的存在都会显著恶化不良心血管事件的结局。这突出了将受损GLS纳入无症状AS风险算法的重要性。
背景:PROSPERO(注册号:CRD42021223472)。
BACKGROUND: The presence of impaired global longitudinal strain (GLS) may be a valuable bio-marker in the early diagnosis for left ventricle (LV) impairment, which would help scrutinize asymptomatic aortic stenosis (AS) patients with high risk of adverse outcomes, such as major adverse cardiovascular events (MACE).
METHODS: The study was prospectively registered in PROPSERO (CRD 42021223472). Databases, such as Pubmed, Embase, Cochrane Library, Web of science, and Scopus were searched for studies evaluating the impact of impaired GLS on MACE, all-cause mortality, and aortic valve replacement (AVR) in asymptomatic AS. Hazard ratios (HRs) with 95% CIs were calculated with meta-analysis for binary variants. Meta-regression, subgroup analysis, and sensitivity analyses were applied as needed to explore the heterogeneity.
RESULTS: Eventually, a total of nine studies reporting 1,512 patients were enrolled. Compared with the normal GLS group, impaired GLS significantly increased MACE (HR = 1.20, 95% CI: 1.10-1.30, I 2 = 79%) with evident heterogeneity, all-cause mortality (HR = 1.42, 95% CI: 1.24-1.63), and AVR (HR = 1.17, 95% CI: 1.07-1.28). Subgroup analyses stratified by left ventricular ejection fraction (LVEF) > 50% or LVEF without precise cut-off point found that compared with the normal GLS group, impaired GLS remarkably increased MACE both in two subgroups (LVEF > 50%: HR: 1.22, 95% CI: 1.05-1.50; LVEF without cutpoint: HR: 1.25, 95% CI: 1.05-1.50). The results stratified by AS severity (mild/moderate and severe) or follow-up time resembled those stratified by LVEF. In addition, when subgroup analysis was stratified by mean aortic valve pressure gradient (MG ≥ 40 mm Hg and MG <40 mm Hg), compared with normal GLS, impaired GLS significantly increased MACE both in two subgroups (MG ≥ 40 mm Hg: HR: 3.41, 95% CI: 1.64-7.09; MG below 40 mm Hg: HR: 3.17, 95% CI: 1.87-5.38). Moreover, the effect sizes here were substantially higher than those in the former two stratified factors.
CONCLUSIONS: The presence of impaired GLS substantially worsens the outcomes for adverse cardiovascular events in asymptomatic patients with AS regardless of LVEF or AS severity or follow-up time or mean aortic valve pressure gradient, which highlights the importance of incorporating impaired GLS into risk algorithms in asymptomatic AS.
BACKGROUND: PROSPERO (registration number: CRD42021223472).