Khan Umael, Omdal Tom R, Matre Knut, Greve Gottfried
Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021, Bergen, Norway.
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Pediatr Cardiol. 2020 Jan;41(1):1-11. doi: 10.1007/s00246-019-02219-8. Epub 2019 Oct 30.
Reference values for left ventricular systolic strain in healthy neonates are necessary for clinical application of strain. The objectives of this systematic review were to identify echocardiographic studies that presented left ventricular strain values in healthy neonates, perform a meta-analysis for speckle tracking-derived global longitudinal strain, and identify areas that require further investigation. A structured search was applied to MEDLINE, Embase, and Cochrane Central Register of Clinical Trials in search of echocardiographic studies that presented left ventricular strain in healthy neonates. 244 studies were identified, of which 16 studies including speckle tracking and tissue Doppler strain in the longitudinal, radial, and circumferential directions passed the screening process. Out of these 16 studies, a meta-analysis was performed on the 10 studies that reported speckle tracking global longitudinal strain. Mean speckle tracking-derived global longitudinal strain was 21.0% (95% Confidence Interval 19.6-22.5%, strain given as positive values). When the studies were divided into subgroups, mean speckle tracking global longitudinal strain from the four-chamber view was 19.5% (95% Confidence Interval 18.0-21.0%) and that derived from all three apical views was 22.5% (95% CI 20.6-24.7%), indicating that global longitudinal strain from the four-chamber view is slightly lower than global longitudinal strain from all three apical views. Neonatal strain values were close to strain values in older subjects found in previous meta-analyses. Further studies are recommended that examine strain rate, segmental strain values, strain derived from short axis views, and strain in the first few hours after birth.
健康新生儿左心室收缩期应变的参考值对于应变的临床应用至关重要。本系统评价的目的是识别呈现健康新生儿左心室应变值的超声心动图研究，对斑点追踪衍生的整体纵向应变进行荟萃分析，并确定需要进一步研究的领域。采用结构化检索方法在MEDLINE、Embase和Cochrane临床试验中央注册库中检索呈现健康新生儿左心室应变的超声心动图研究。共识别出244项研究，其中16项包括纵向、径向和圆周方向的斑点追踪及组织多普勒应变的研究通过了筛选过程。在这16项研究中，对报告了斑点追踪整体纵向应变的10项研究进行了荟萃分析。斑点追踪衍生的平均整体纵向应变为21.0%（95%置信区间19.6 - 22.5%，应变以正值表示）。当将研究分为亚组时，四腔心切面的斑点追踪平均整体纵向应变为19.5%（95%置信区间18.0 - 21.0%），而从所有三个心尖切面得出的为22.5%（95%CI 20.6 - 24.7%），这表明四腔心切面的整体纵向应变略低于所有三个心尖切面的整体纵向应变。新生儿的应变值与先前荟萃分析中发现的老年受试者的应变值相近。建议进一步开展研究，以检查应变率、节段性应变值、短轴切面衍生的应变以及出生后头几个小时内的应变。
