背景:左心房(LA)附件封堵术(LAAC)对不适合长期抗凝治疗的房颤患者有效。然而,LAAC对LA功能的影响未知.本研究的目的是评估LAAC对心房功能的影响。
方法:本荟萃分析是根据系统评价和荟萃分析指南的首选报告项目进行的。搜索策略旨在利用PubMed/Medline,EMBASE,和谷歌学者进行的研究显示了LAAC从成立到2021年11月20日对LA功能的影响。从平均值和标准偏差计算标准化平均差(SMD)。
结果:在最初确定的247项研究中,包括260名患者的8项研究被纳入最终分析。与术前功能相比,LAAC后LA排空分数显着增加(SMD:0.53;95%置信区间[CI]:0.04-1.01;p=.03;I2=75%)。相比之下,LA体积没有显着差异(SMD:-0.07;95%CI:-0.82-0.69;p=.86;I2=92%)峰值心房纵向应变(SMD:0.50;95%CI:-0.08-1.08;p=.09;I2=89%),心房收缩应变峰值(SMD:0.38;95%CI:-0.22-0.99;p=.21;I2=81%),心房收缩期间的应变(SMD:-0.24;95%CI:-0.61-0.13;p=.20;I2=0%),心室收缩期应变(SMD:0.47;95%CI:-0.32-1.27;p=.24;I2=89%),心室舒张期应变(SMD:0.09;95%CI:-0.32-0.51;p=.66;I2=65%)。
结论:LAAC与左心房排空分数的改善有关,但没有显著影响其他参数。
BACKGROUND: Left atrial (LA) appendage closure (LAAC) is effective in patients with atrial fibrillation who are not candidates for long-term anticoagulation. However, the impact of LAAC on LA function is unknown. The aim of this study is to evaluate the impact of LAAC on atrial function.
METHODS: This meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search strategy was designed to utilize PubMed/Medline, EMBASE, and Google scholar for studies showing the effect of LAAC on the LA function from inception to November 20, 2021. The standardized mean difference (SMD) was calculated from the means and standard deviations.
RESULTS: Of 247 studies initially identified, 8 studies comprising 260 patients were included in the final analysis. There was a significant increase in LA emptying fraction following LAAC compared with preoperative function (SMD: 0.53; 95% confidence interval [CI]: 0.04-1.01; p = .03; I2 = 75%). In contrast, there were no significant differences in LA volume (SMD: -0.07; 95% CI: -0.82-0.69; p = .86; I2 = 92%) peak atrial longitudinal strain (SMD: 0.50; 95% CI: -0.08-1.08; p = .09; I2 = 89%), peak atrial contraction strain (SMD: 0.38; 95% CI: -0.22-0.99; p = .21; I2 = 81%), strain during atrial contraction (SMD: -0.24; 95% CI: -0.61-0.13; p = .20; I2 = 0%), strain during ventricular systole (SMD: 0.47; 95% CI: -0.32-1.27; p = .24; I2 = 89%), strain during ventricular diastole (SMD: 0.09; 95% CI: -0.32-0.51; p = .66; I2 = 65%).
CONCLUSIONS: LAAC is associated with improvement in the left atrial emptying fraction, but did not significantly influence other parameters.