Department of Pediatrics and Biostatistics and Clinical Epidemiology, University of Toyama, Toyama, Japan
Department of Pediatrics and Biostatistics and Clinical Epidemiology, University of Toyama, Toyama, Japan.
Open Heart. 2022 May;9(1). doi: 10.1136/openhrt-2021-001908.
Left ventricular non-compaction (LVNC) is morphologically characterised by excessive trabeculations and deep recesses in the ventricular wall. The risk of thromboembolic disease in the paediatric patients with LVNC has not been clearly established. We conducted this systematic review to evaluate the prevalence and incidence of thromboembolism (TE) in paediatric and adult patients with LVNC and searched for risk factors for TE to explore management strategies.
The primary outcome was the prevalence and incidence of TE in the patients with LVNC. The secondary outcome was the TE and mortality and heart transplantation rates between paediatric and adult patients with LVNC. We searched for studies published in MEDLINE, Embase and Cochrane Central Register of Controlled Trials between January 1950 and December 2020. A systematic search of keywords related to LVNC, anticoagulants/antiplatelets and TE was conducted. Studies that did not present original research, non-human studies, duplicated studies were excluded.
Fifty-seven studies met the inclusion criteria. A total of 726 paediatric and 3862 adult patients were included. The mean prevalence rates of TE in the paediatric and adult patients with LVNC were 2.6% and 6.2% (I=0%; p<0.450 and I=73.7%; p<0.001), respectively. The mean annual incidences of TE in paediatric and adult patients with LVNC were 1.4% and 2.9% (I=99.4%; p<0.001 and I=99.5%; p<0.001), respectively. Multivariate logistic regression analysis showed that TE was associated with left ventricular ejection fraction in <40% of paediatric patients (OR, 9.47; 95% CI, 1.35 to 188.23; p=0.0225).
The prevalence and incidence rates in paediatric patients were lower than those in adult patients. TE was associated with a reduced systolic function in paediatric patients with LVNC.
左心室心肌致密化不全（LVNC）的形态学特征为心室壁有过多的小梁和深陷的隐窝。LVNC 患儿发生血栓栓塞性疾病的风险尚未明确。我们进行了这项系统综述，以评估 LVNC 患儿和成年患者中血栓栓塞（TE）的发生率和患病率，并寻找 TE 的危险因素，以探讨管理策略。
主要结局为 LVNC 患者的 TE 发生率和患病率。次要结局为 LVNC 患儿和成年患者的 TE 和死亡率及心脏移植率。我们检索了 1950 年 1 月至 2020 年 12 月期间在 MEDLINE、Embase 和 Cochrane 中心对照试验注册库发表的研究。系统地检索了与 LVNC、抗凝/抗血小板和 TE 相关的关键词。排除未提出原始研究、非人类研究和重复研究的文章。
57 项研究符合纳入标准。共纳入 726 例儿科和 3862 例成年 LVNC 患者。LVNC 儿科和成年患者的 TE 平均患病率分别为 2.6%和 6.2%（I=0%；p<0.450 和 I=73.7%；p<0.001）。LVNC 儿科和成年患者的 TE 平均年发生率分别为 1.4%和 2.9%（I=99.4%；p<0.001 和 I=99.5%；p<0.001）。多变量逻辑回归分析显示，TE 与 LVNC 儿科患者左心室射血分数<40%有关（OR，9.47；95%CI，1.35 至 188.23；p=0.0225）。
儿科患者的患病率和发生率低于成年患者。TE 与 LVNC 儿科患者收缩功能降低有关。
