Morris Daniel Armando, Ma Xin-Xin, Belyavskiy Evgeny, Aravind Kumar Radhakrishnan, Kropf Martin, Kraft Robin, Frydas Athanasios, Osmanoglou Engin, Marquez Esteban, Donal Erwan, Edelmann Frank, Tschöpe Carsten, Pieske Burkert, Pieske-Kraigher Elisabeth
Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, DZHK (German Centre for Cardiovascular Research) partner site Berlin and Berlin Institute of Health (BIH), Berlin, Germany.
Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China.
Open Heart. 2017 Sep 25;4(2):e000630. doi: 10.1136/openhrt-2017-000630. eCollection 2017.
The purpose of this meta-analysis was to confirm if the global longitudinal systolic function of the left ventricle (LV) is altered in patients with heart failure with preserved ejection fraction (HFpEF).
We searched in different databases (Medline, Embase and Cochrane) studies that analysed LV global longitudinal systolic strain (GLS) in patients with HFpEF and in controls (such as healthy subjects or asymptomatic patients with arterial hypertension, diabetes mellitus or coronary artery disease).
Twenty-two studies (2284 patients with HFpEF and 2302 controls) were included in the final analysis. Patients with HFpEF had significantly lower GLS than healthy subjects (mean -15.7% (range -12% to -18.9%) vs mean -19.9% (range -17.1% to -21.5%), weighted mean difference -4.2% (95% CI -3.3% to -5.0%), p < 0.001, respectively). In addition, patients with HFpEF had also significantly lower GLS than asymptomatic patients (mean -15.5% (range -13.4% to -18.4%) vs mean -18.3% (range -15.1% to -20.4%), weighted mean difference -2.8%(95% CI -1.9% to -3.6%), p < 0.001, respectively). In line, 10 studies showed that the rate of abnormal GLS was significantly higher in patients with HFpEF (mean 65.4% (range 37%-95%)) than in asymptomatic subjects (mean 13% (range 0%-29.6%)). Regarding the prognostic relevance of abnormal GLS in HFpEF, two multicentre studies with large sample size (447 and 348) and high number of events (115 and 177) showed that patients with abnormal GLS had worse cardiovascular (CV) outcomes than those with normal GLS (HR for CV mortality and HF hospitalisation 2.14 (95% CI 1.26 to 3.66) and 1.94 (95% CI 1.22 to 3.07)), even adjusting these analyses for multiples clinical and echocardiographic variables.
The present meta-analysis analysing 2284 patients with HFpEF and 2302 controls confirms that the longitudinal systolic function of the LV is significantly altered in high proportion of patients with HFpEF. Further large multicentre studies with the aim to confirm the prognostic role of abnormal GLS in HFpEF are warranted.
本荟萃分析的目的是确认射血分数保留的心力衰竭（HFpEF）患者左心室（LV）的整体纵向收缩功能是否发生改变。
我们在不同数据库（Medline、Embase和Cochrane）中检索分析HFpEF患者及对照组（如健康受试者或无症状的动脉高血压、糖尿病或冠状动脉疾病患者）左心室整体纵向收缩应变（GLS）的研究。
最终分析纳入了22项研究（2284例HFpEF患者和2302例对照）。HFpEF患者的GLS显著低于健康受试者（分别为平均-15.7%（范围-12%至-18.9%）与平均-19.9%（范围-17.1%至-21.5%），加权平均差-4.2%（95%CI -3.3%至-5.0%），p<0.001）。此外，HFpEF患者的GLS也显著低于无症状患者（分别为平均-15.5%（范围-13.4%至-18.4%）与平均-18.3%（范围-15.1%至-20.4%），加权平均差-2.8%（95%CI -1.
