State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China.
Eur Radiol. 2021 Jun;31(6):3898-3908. doi: 10.1007/s00330-020-07481-6. Epub 2020 Nov 17.
Right ventricular (RV) function is considered the major determinant of prognosis in patients with chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this meta-analysis was to evaluate RV remodelling and function following balloon pulmonary angioplasty (BPA) in patients with inoperable CTEPH or persistent/recurrent pulmonary hypertension (PH) after pulmonary endarterectomy (PEA).
We reviewed all studies evaluating RV function by cardiac magnetic resonance (CMR) and/or echocardiography pre- and post-BPA from PubMed/Medline prior to 15 December 2019. Ten (299 patients) of the 29 studies retrieved met the inclusion criteria: 5 CMR and 5 echocardiography studies. The systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines.
Pooled data from CMR studies revealed BPA resulted in a significantly decreased RV end-diastolic volume index (weighted mean difference (WMD) - 28.33 ml/m, p < 0.00001) and RV end-systolic volume index (WMD - 29.06 ml/m, p < 0.00001) accompanied by an increased RV ejection fraction (RVEF, WMD 8.97%, p < 0.00001). Data from the echocardiography studies showed BPA resulted in decreased RV basal diameter (WMD - 0.37 cm, p = 0.0009) and an increase of RV fractional area change (WMD 5.97 %, p = 0.003), but improvements of tricuspid annular plane systolic excursion (TAPSE) and S' were not significant.
BPA improves RVEF and decreases RV volumes in patients with inoperable CTEPH or persistent/recurrent PH after PEA.
• Balloon pulmonary angioplasty improves RVEF and decreases RV volumes in patients with inoperable CTEPH or persistent/recurrent PH after PEA.
右心室（RV）功能被认为是慢性血栓栓塞性肺动脉高压（CTEPH）患者预后的主要决定因素。本荟萃分析的目的是评估无法手术的 CTEPH 或肺动脉内膜剥脱术（PEA）后持续性/复发性肺动脉高压（PH）患者行球囊肺动脉成形术（BPA）后的 RV 重塑和功能。
我们检索了 2019 年 12 月 15 日前在 PubMed/Medline 上发表的所有通过心脏磁共振（CMR）和/或超声心动图评估 RV 功能的研究，评估 BPA 前后的 RV 功能。29 项研究中，有 10 项（299 例患者）符合纳入标准：5 项 CMR 研究和 5 项超声心动图研究。系统评价和荟萃分析遵循系统评价和荟萃分析的首选报告项目指南。
CMR 研究的汇总数据显示，BPA 可显著降低 RV 舒张末期容积指数（加权均数差（WMD）-28.33ml/m，p<0.00001）和 RV 收缩末期容积指数（WMD-29.06ml/m，p<0.00001），同时 RV 射血分数（RVEF，WMD 8.97%，p<0.00001）增加。超声心动图研究的数据显示，BPA 可使 RV 基底直径减小（WMD-0.37cm，p=0.0009），RV 节段面积变化增加（WMD 5.97%，p=0.003），但三尖瓣环平面收缩期位移（TAPSE）和 S'的改善无统计学意义。
BPA 可改善无法手术的 CTEPH 或 PEA 后持续性/复发性 PH 患者的 RVEF 并降低 RV 容积。
• 球囊肺动脉成形术可改善无法手术的 CTEPH 或 PEA 后持续性/复发性 PH 患者的 RVEF 并降低 RV 容积。
