Department of General Surgery, Zhengzhou People's Hospital, Zhengzhou, Henan, China
Department of Emergency, Shangcai People's Hospital, Shangcai, Henan, China.
BMJ Open. 2020 Sep 22;10(9):e031316. doi: 10.1136/bmjopen-2019-031316.
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).
Systematic review and meta-analysis.
To identify potential publications, a comprehensive literature search through MEDLINE, the Cochrane database and the Embase database was performed up to December 2019.
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.
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.
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.
The meta-analysis suggested that enlarged RAA/RAAI were associated with increased risk of poor prognosis in patients with PAH.
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。
系统评价和荟萃分析。
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。
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。
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。
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。
荟萃分析表明，RAA/RAAI 增大与 PAH 患者预后不良风险增加相关。
