经皮房间隔缺损封堵术后肺动脉高压的患病率和结局：系统评价和荟萃分析。
Prevalence and outcomes of pulmonary hypertension after percutaneous closure of atrial septal defect: a systematic review and meta-analysis.
机构信息
Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.
Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.
出版信息
Eur Respir Rev. 2020 Dec 15;29(158). doi: 10.1183/16000617.0099-2020. Print 2020 Dec 31.
BACKGROUND
Atrial septal defect (ASD) is a common form of congenital heart disease. Significant shunts may increase the risk of developing pulmonary hypertension (PH). We aimed to describe current PH definitions, evaluate PH prevalence and the effect of PH on outcomes in patients undergoing percutaneous ASD closure.
METHODS
EMBASE, MEDLINE and Cochrane databases were systematically searched. Studies reporting PH prevalence or mean systolic pulmonary arterial pressure (sPAP) before and after percutaneous ASD closure in adults were included. We conducted meta-analyses to obtain summary estimates for PH prevalence and mean sPAP.
RESULTS
15 articles with a total of 1073 patients met the eligibility criteria. Studies applied variable PH definitions. PH prevalence and mean sPAP levels decreased in all studies after closure. The pooled PH prevalence decreased from 44% (95% CI 29-60%) to 18% (95% CI 8-27%). The overall standardised mean difference in sPAP was 1.12 (95% CI 0.81-1.44) and 1.62 (95% CI 1.00-2.23) in cohort and case-series studies respectively indicating a large decrease. The pooled standard mean difference among the younger and older patients were different, 1.25 (95% CI 0.78-1.71) and 0.91 (95% CI 0.56-1.27), respectively. A high degree of between-study heterogeneity was noted.
CONCLUSIONS
Both PH prevalence and mean sPAP decrease after ASD closure. Larger, prospective studies with consistent PH definitions using the recommended measurement modality are warranted.
背景
房间隔缺损（ASD）是一种常见的先天性心脏病。大量分流可能会增加肺动脉高压（PH）的风险。我们旨在描述当前 PH 的定义，评估经皮 ASD 闭合患者中 PH 的患病率及其对结局的影响。
方法
系统检索了 EMBASE、MEDLINE 和 Cochrane 数据库。纳入了报告成人经皮 ASD 闭合前后 PH 患病率或平均收缩期肺动脉压（sPAP）的研究。我们进行了荟萃分析，以获得 PH 患病率和平均 sPAP 的汇总估计值。
结果
共有 15 项研究，总计 1073 名患者符合入选标准。研究采用了不同的 PH 定义。闭合后所有研究的 PH 患病率和平均 sPAP 水平均降低。汇总的 PH 患病率从 44%（95%CI 29-60%）降至 18%（95%CI 8-27%）。整体标准化均数差值在队列研究和病例系列研究中分别为 1.12（95%CI 0.81-1.44）和 1.62（95%CI 1.00-2.23），表明有较大降幅。年龄较小和较大患者的汇总标准均数差值分别为 1.25（95%CI 0.78-1.71）和 0.91（95%CI 0.56-1.27）。研究间存在高度异质性。
结论
ASD 闭合后 PH 患病率和平均 sPAP 均降低。需要更大规模、前瞻性研究，采用一致的 PH 定义和推荐的测量方法。
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