Bytyçi Ibadete, Bajraktari Gani, Lindqvist Per, Henein Michael Y
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Umeå Heart Centre, Umeå, Sweden.
Clin Physiol Funct Imaging. 2019 Sep;39(5):297-307. doi: 10.1111/cpf.12587. Epub 2019 Jun 25.
This meta-analysis assesses left atrial (LA) cavity and myocardial function measurements that predict pulmonary capillary wedge pressure (PCWP).
PubMed-MEDLINE, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry were searched up to December 2018 for studies on the relationship of LA diameter, LA indexed volume (LAVI max, LAVI min), peak atrial longitudinal (PALS), peak atrial contraction (PACS) strain and total emptying fraction (LAEF) with PCWP. Eighteen studies with 1343 patients were included. Summary sensitivity and specificity (with 95% CI) for evaluation of diagnostic accuracy and the best cut-off values for different LA indices in predicting raised PCWP were estimated using summary receiver operating characteristic analysis.
The pooled analysis showed association between PCWP and LA diameter: Cohen's d = 0·87, LAVI max: d = 0·92 and LAVI min: d = 1·0 (P<0·001 for all). A stronger correlation was found between PCWP and PALS: d = 1·26, and PACS: d = 1·62, total EF d = 1·22 (P<0·0001 for all). PALS ≤19% had a summary sensitivity of 80% (65-90) and summary specificity of 77% (52-92), positive likelihood ratio (LR+) 3·74, negative likelihood ratio (LR-) <0·25 and DOR > 15·1 whereas LAVI ≥34 ml m had summary sensitivity of 75% (55-89) and summary specificity 77% (57-90), with LR+ >3, LR- 0·32 and DOR >10·1.
Compromised LA myocardial function and increased size predict raised cavity pressure. These results should assist in optimum follow-up of patients with fluctuating LA pressure.
本荟萃分析评估预测肺毛细血管楔压（PCWP）的左心房（LA）腔及心肌功能测量指标。
检索截至2018年12月的PubMed-MEDLINE、EMBASE、Scopus、谷歌学术和Cochrane中心注册库，查找关于LA直径、LA指数化容积（LAVI max、LAVI min）、心房纵向峰值（PALS）、心房收缩峰值（PACS）应变及总排空分数（LAEF）与PCWP关系的研究。纳入18项研究共1343例患者。采用汇总受试者工作特征分析评估诊断准确性的汇总敏感性和特异性（及95%可信区间），并估计不同LA指标预测升高的PCWP时的最佳截断值。
汇总分析显示PCWP与LA直径之间存在关联：Cohen's d = 0·87，LAVI max：d = 0·92，LAVI min：d = 1·0（均P<0·001）。PCWP与PALS之间的相关性更强：d = 1·26，PACS：d = 1·62，总EF d = 1·22（均P<0·0001）。PALS≤19%时汇总敏感性为80%（65 - 90），汇总特异性为77%（52 - 92），阳性似然比（LR+）为3·74，阴性似然比（LR-）<0·25，诊断比值比（DOR）>15·1；而LAVI≥34 ml/m时汇总敏感性为75%（55 - 89），汇总特异性为77%（57 - 90），LR+>3，LR-为0·32，DOR>10·1。
LA心肌功能受损及大小增加可预测腔压力升高。这些结果应有助于对LA压力波动患者进行最佳随访。
