Department of Internal Medicine, Unity Hospital, Rochester Regional Health System, Rochester, NY, USA.
Department of Internal Medicine, Henry Ford Allegiance Health, Jackson, MI, USA.
Echocardiography. 2020 Dec;37(12):2061-2070. doi: 10.1111/echo.14886. Epub 2020 Oct 15.
This meta-analysis aims to evaluate the utility of speckle tracking echocardiography (STE) as a tool to evaluate for cardiac sarcoidosis (CS) early in its course. Electrocardiography and echocardiography have limited sensitivity in this role, while advanced imaging modalities such as cardiac magnetic resonance (CMR) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) are limited by cost and availability.
We compiled English language articles that reported left ventricular global longitudinal strain (LVGLS) or global circumferential strain (GCS) in patients with confirmed extra-cardiac sarcoidosis versus healthy controls. Studies that exclusively included patients with probable or definite CS were excluded. Continuous data were pooled as a standard mean difference (SMD), comparing sarcoidosis group with healthy controls. A random-effect model was adopted in all analyses. Heterogeneity was assessed using Q and I2 statistics.
Nine studies were included in our final analysis with an aggregate of 967 patients. LVGLS was significantly lower in the extra-cardiac sarcoidosis group as compared with controls, SMD -3.98, 95% confidence interval (CI): -5.32, -2.64, P < .001, also was significantly lower in patients who suffered major cardiac events (MCE), -3.89, 95% CI -6.14, -1.64, P < .001. GCS was significantly lower in the extra-cardiac sarcoidosis group as compared with controls, SMD: -3.33, 95% CI -4.71, -1.95, P < .001.
LVGLS and GCS were significantly lower in extra-cardiac sarcoidosis patients despite not exhibiting any cardiac symptoms. LVGLS correlates with MCEs in CS. Further studies are required to investigate the role of STE in the early screening of CS.
本荟萃分析旨在评估斑点追踪超声心动图（STE）作为一种早期评估心脏结节病（CS）的工具的效用。心电图和超声心动图在这方面的敏感性有限，而心脏磁共振（CMR）和 18F-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）等高级成像方式则受到成本和可用性的限制。
我们汇编了报告了确诊的心脏外结节病患者与健康对照组之间左心室整体纵向应变（LVGLS）或整体周向应变（GCS）的英文文献。仅包括可能或明确 CS 患者的研究被排除在外。连续数据以标准均数差（SMD）汇总，比较结节病组与健康对照组。所有分析均采用随机效应模型。使用 Q 和 I2 统计量评估异质性。
最终分析共纳入 9 项研究，共 967 例患者。与对照组相比，心脏外结节病组的 LVGLS 明显较低，SMD-3.98，95%置信区间（CI）：-5.32，-2.64，P<0.001，在发生重大心脏事件（MCE）的患者中也明显较低，SMD-3.89，95%CI-6.14，-1.64，P<0.001。与对照组相比，心脏外结节病组的 GCS 明显较低，SMD：-3.33，95%CI-4.71，-1.95，P<0.001。
尽管没有任何心脏症状，心脏外结节病患者的 LVGLS 和 GCS 明显较低。LVGLS 与 CS 中的 MCE 相关。需要进一步研究来探讨 STE 在 CS 早期筛查中的作用。
