主动脉瓣狭窄患者经导管主动脉瓣置换术后新发左束支传导阻滞的预后结果：一项系统评价和荟萃分析
Prognostic Outcome of New-Onset Left Bundle Branch Block After Transcatheter Aortic Valve Replacement in Patients With Aortic Stenosis: A Systematic Review and Meta-Analysis.
作者信息
Wang Jialu, Liu Shidong, Han Xiangxiang, Chen Yang, Chen Hao, Wan Zunhui, Song Bing
机构信息
The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China.
Department of Cardiovascular Surgery, First Hospital of Lanzhou University, Lanzhou, China.
出版信息
Front Cardiovasc Med. 2022 Apr 8;9:842929. doi: 10.3389/fcvm.2022.842929. eCollection 2022.
BACKGROUND
Left bundle branch block (LBBB) is a common complication of the transcatheter aortic valve replacement (TAVR), and its impact on prognosis is controversial.
METHODS
A comprehensive electronic search was conducted in databases (PubMed, Embase, Cochrane Library, and The Web of Science), from the date of database establishment till March 2021, to screen for studies on new-onset LBBB after TAVR. We next performed a meta-analysis to evaluate the effect of new-onset LBBB after TAVR on patient prognosis, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.
RESULTS
A total of 17 studies, including 9205 patients, were eligible for our analysis. Patients with new-onset LBBB had elevated all-cause mortality risk verses patients without new-onset LBBB, during all follow ups. The relevant data are as follows: 30-day (RR:1.71; 95%CI:1.27-2.29; < 0.001), 1-year (RR:1.31; 95%CI:1.12-1.52; < 0.001), and 2-year (RR:1.31; 95%CI:1.09-1.56; = 0.003) follow ups. Likewise, new-onset LBBB patients also experienced increased cardiovascular mortality, compared to non-new-onset LBBB patients, but only in the 1-year follow up (RR:1.49; 95%CI:1.23-1.82; < 0.001). Hospitalization for heart failure was dramatically elevated in patients with new-onset LBBB verses non-new-onset LBBB, in all follow ups. The relevant data are as follows: 30-day (RR:1.56; 95%CI:1.13-2.12; = 0.007), 1-year (RR:1.35; 95%CI:1.08-1.68; = 0.007), and 2-year (RR:1.49; 95%CI:1.21-1.84; < 0.001). Similarly, new-onset LBBB patients had higher PPI risk than non-new-onset LBBB patients, in all follow ups. The relevant data are as follows: 30-day (RR:3.05; 95%CI:1.49-6.22; = 0.002), 1-year (RR:2.15; 95%CI:1.52-3.03; < 0.001), and 2-year (RR:2.52; 95%CI:1.68-3.78; < 0.001).
CONCLUSION
Patients with new-onset LBBB have worse prognosis after TAVR than those without new-onset LBBB. Recognition of the adverse effects of post-TAVR new-onset LBBB can lead to the development of new strategies that enhance clinical outcomes.
SYSTEMATIC TRIAL REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=197224, identifier: 19722.
背景
左束支传导阻滞（LBBB）是经导管主动脉瓣置换术（TAVR）的常见并发症，其对预后的影响存在争议。
方法
对数据库（PubMed、Embase、Cochrane图书馆和科学网）进行全面的电子检索，检索时间从数据库建立之日至2021年3月，以筛选关于TAVR术后新发LBBB的研究。接下来，我们根据系统评价和Meta分析的首选报告项目（PRISMA）声明进行Meta分析，以评估TAVR术后新发LBBB对患者预后的影响。
结果
共有17项研究，包括9205例患者，符合我们的分析标准。在所有随访期间，新发LBBB患者的全因死亡风险高于未发生新发LBBB的患者。相关数据如下：30天（RR：1.71；95%CI：1.27 - 2.29；P < 0.001）、1年（RR：1.31；95%CI：1.12 - 1.52；P < 0.001）和2年（RR：1.31；95%CI：1.09 - 1.56；P = 0.003）随访。同样，与未发生新发LBBB的患者相比，新发LBBB患者的心血管死亡率也有所增加，但仅在1年随访中（RR：1.49；95%CI：1.23 - 1.82；P < 0.001）。在所有随访中，新发LBBB患者因心力衰竭住院的比例显著高于未发生新发LBBB的患者。相关数据如下：30天（RR：1.56；95%CI：1.13 - 2.12；P = 0.007）、1年（RR：1.35；95%CI：1.08 - 1.68；P = 0.007）和2年（RR：1.49；95%CI：1.21 - 1.84；P < 0.001）。同样，在所有随访中，新发LBBB患者发生永久性起搏器植入（PPI）的风险高于未发生新发LBBB的患者。相关数据如下：30天（RR：3.05；95%CI：1.49 - 6.22；P = 0.002）、1年（RR：2.15；95%CI：1.52 - 3.03；P < 0.001）和2年（RR：2.52；95%CI：1.68 - 3.78；P < 0.001）。
结论
TAVR术后新发LBBB患者的预后比未发生新发LBBB的患者更差。认识到TAVR术后新发LBBB的不良影响有助于制定改善临床结局的新策略。
系统评价注册
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=197224，标识符：19722 。
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