超声心动图测量的右心房面积与肺动脉高压预后的关系：系统评价和荟萃分析。
Association between right atrial area measured by echocardiography and prognosis among pulmonary arterial hypertension: a systematic review and meta-analysis.
机构信息
Department of General Surgery, Zhengzhou People's Hospital, Zhengzhou, Henan, China
Department of Emergency, Shangcai People's Hospital, Shangcai, Henan, China.
出版信息
BMJ Open. 2020 Sep 22;10(9):e031316. doi: 10.1136/bmjopen-2019-031316.
OBJECTIVE
The purpose of this meta-analysis was to evaluate the association between enlarged right atrial area (RAA), as measured by echocardiography, and prognosis of patients with pulmonary arterial hypertension (PAH).
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
To identify potential publications, a comprehensive literature search through MEDLINE, the Cochrane database and the Embase database was performed up to December 2019.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Studies were included if they reported Cox regression based-HRs with 95% CIs for all-cause mortality or composite endpoint consisting of death and PAH-related events for echocardiography measurements of the RAA or the right atrial area index (RAAI) in patients with PAH.
DATA EXTRACTION AND SYNTHESIS
The unadjusted HR with 95% CI was extracted for the final pooled analysis. A random-effects model was used to determine the value of RAA/RAAI in the prognosis of patients with PAH. The data heterogeneity among the studies was estimated by the I statistic and the Cochran Q-statistic.
RESULTS
Twelve studies with a total of 1085 patients with PAH were finally included in the meta-analysis. These studies had a mean follow-up time ranging from 9.2 months to 5.0 years. Their findings showed that patients with PAH with enlarged RAA/RAAI were associated with poor prognosis. The risk of all-cause mortality in patients with PAH was found to statistically increase by 50% for every 5-unit increase in RAA/RAAI (HR 1.50, 95% CI 1.28 to 1.75, p<0.001). Similarly, the risk of the composite endpoint also significantly increased by 53% for every 5-unit increase in RAA/RAAI (HR 1.53, 95% CI 1.23 to 1.89, p<0.001). Subgroup analyses in which the patients were stratified by RAA and RAAI were consistent with the main results.
CONCLUSION
The meta-analysis suggested that enlarged RAA/RAAI were associated with increased risk of poor prognosis in patients with PAH.
目的
本荟萃分析旨在评估超声心动图测量的右心房面积（RAA）增大与肺动脉高压（PAH）患者预后的关系。
设计
系统评价和荟萃分析。
数据来源
通过 MEDLINE、Cochrane 数据库和 Embase 数据库进行全面文献检索，以确定潜在的出版物，检索时间截至 2019 年 12 月。
研究入选标准
纳入的研究报告了 Cox 回归基础风险比（HR），95%置信区间（CI）为所有原因死亡率或由超声心动图测量的 RAA 或右心房面积指数（RAAI）组成的复合终点，用于 PAH 患者。
数据提取和综合
提取最终汇总分析的未经调整的 HR 及其 95%CI。使用随机效应模型确定 RAA/RAAI 在 PAH 患者预后中的价值。通过 I 统计量和 Cochran Q 统计量评估研究之间的数据异质性。
结果
最终纳入了 12 项研究，共 1085 例 PAH 患者。这些研究的平均随访时间从 9.2 个月到 5.0 年不等。他们的研究结果表明，RAA/RAAI 增大的 PAH 患者预后不良。与 RAA/RAAI 每增加 5 个单位相比，PAH 患者全因死亡率的风险增加 50%（HR 1.50，95%CI 1.28 至 1.75，p<0.001）。同样，RAA/RAAI 每增加 5 个单位，复合终点的风险也显著增加 53%（HR 1.53，95%CI 1.23 至 1.89，p<0.001）。按 RAA 和 RAAI 分层的亚组分析与主要结果一致。
结论
荟萃分析表明，RAA/RAAI 增大与 PAH 患者预后不良风险增加相关。
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