■右心室功能障碍(RVD)与急性肺栓塞(PE)的不良结局有关。然而,没有描述长期的研究,全谱右心室形态学参数,PE发病后某些随访时间点的压力和功能。对右心室功能的更多探索将为PE患者的长期管理提供有用的线索。
■对于本系统综述和荟萃分析,我们在Pubmed完成了文献检索,EMBASE和WebofScience(从1月1日开始,1998年4月20日,2023年)。包括对急性PE患者的研究,随访时间超过3个月,并进行右心室评估并用英语书写。通过超声心动图或计算机断层扫描肺动脉造影(CTPA)评估右心室功能。主要结果是右心室的结构和功能参数,次要结局是功能评估[纽约心脏协会(NYHA)功能分类和6分钟步行测试距离(6MWD)],在每个随访时间点。使用R软件(PROSPERO:CRD42023433332)进行随机效应荟萃分析。
■共有33项研究(3920名患者)纳入最终分析。三个月,右心室功能障碍(RVD)的6个月和1年患病率为0.34[95%置信区间(CI)0.21-0.48,I2=96%],0.26(95%CI0.17-0.36,I2=93%)和0.34(95%CI0.19-0.48,I2=94%),分别。三尖瓣环汇集平面收缩期偏移(TAPSE),右心室与左心室直径(RV/LV)比值和1年肺动脉收缩压(PASP)为21.80mm(95%CI20.08-23.52,I2=93%),0.64(95%CI0.48-0.81,I2=92%)和27.33mmHg(95%CI18.88-35.78)(I2=96%),分别。NYHAIII-IV的比例为0.06(95%CI0.0-0.12),合并的6MWD为462.98m(95%CI447.55-478.41)。接受溶栓治疗的患者的RVD患病率较低(在全身溶栓和导管溶栓中,1年为0.17和0.07,分别)与单用抗凝治疗的患者(1年0.24)相比,但合并风险比(RR)无统计学意义.
■尽管本研究的结论可能受到不同研究设计的高度异质性的限制,每个研究的纳入标准和RVD的定义,我们的研究结果表明,在急性PE后的长期随访中,持续性RVD和功能损害的患病率相当高.治疗策略可能会影响长期RVD的患病率。
■本研究得到了CAMS医学科学创新基金(CIFMS)(2021-I2M-1-061)的支持。国家重点研究发展计划(2016YFC0905600).国家高级医院临床研究资助(2022-NHLHCRF-LX-01-02-03)。CAMS呼吸医学研究所青年学者资助(2023-ZF-8)。
UNASSIGNED: Right ventricular dysfunction (RVD) is associated with adverse outcomes of acute pulmonary embolism (PE). However, there are no studies describing the long-term, full-spectrum right ventricular parameters on morphology, pressure and function at certain follow-up time points after PE onset. More exploration of right ventricular function would provide useful clues for long-term management of patients with PE.
UNASSIGNED: For this systematic
review and meta-analysis, we completed a literature search in Pubmed, EMBASE and WebofScience (from Jan 1st, 1998 to April 20th, 2023). Studies of patients with acute PE followed-up longer than 3 months with right ventricle assessment and written in English-language were included. Right ventricular function was assessed by either echocardiography or computed tomographic pulmonary angiography (CTPA). The primary outcome was structural and functional parameters of the right ventricle, and the secondary outcomes were functional assessments [New York Heart Association (NYHA) functional classification and 6-min walk test distance (6 MWD)], at each follow-up time points. Random effect meta-analyses were performed using R software (PROSPERO: CRD42023433332).
UNASSIGNED: A total of 33 studies (3920 patients) were included in the final analysis. The 3-month, 6-month and 1-year prevalence of right ventricular dysfunction (RVD) was 0.34 [95% confidence interval (CI) 0.21-0.48, I2 = 96%], 0.26 (95% CI 0.17-0.36, I2 = 93%) and 0.34 (95% CI 0.19-0.48, I2 = 94%), respectively. Pooled tricuspid annulus plane systolic excursion (TAPSE), right ventricular to left ventricular diameter (RV/LV) ratio and pulmonary artery systolic pressure (PASP) at 1-year was 21.80 mm (95% CI 20.08-23.52, I2 = 93%), 0.64 (95% CI 0.48-0.81, I2 = 92%) and 27.33 mmHg (95% CI 18.88-35.78) (I2 = 96%), respectively. The proportion of NYHA III-IV was 0.06 (95% CI 0.0-0.12) and the pooled 6 MWD was 462.98 m (95% CI 447.55-478.41) over 1 year. Patients treated with thrombolysis had lower prevalence of RVD (1-year 0.17 and 0.07 in systemic thrombolysis and catheter-directed thrombolysis, respectively) than those treated with anticoagulation therapy alone (1-year 0.24) but the pooled risk ratio (RR) was not statistically significant.
UNASSIGNED: Although the conclusion of this study may be limited by its high heterogeneity from varied study designs, inclusion criteria and definition of RVD of each study, our findings suggested that persistent RVD and functional impairment were of considerable high prevalence during long-term follow-up after acute PE. Treatment strategy may influence the prevalence of long-term RVD.
UNASSIGNED: This study is supported by CAMS Innovation Fund for Medical Sciences (CIFMS) (2021-I2M-1-061). The National Key Research and Development Program of China (2016YFC0905600). National High Level Hospital Clinical Research Funding (2022-NHLHCRF-LX-01-02-03). CAMS Institute of Respiratory Medicine Grant for Young Scholars (2023-ZF-8).