Xiao Yangjie, Bi Wenjing, Qiao Wei, Wang Xin, Li Ying, Ren Weidong
Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China.
Front Cardiovasc Med. 2022 Aug 24;9:965440. doi: 10.3389/fcvm.2022.965440. eCollection 2022.
Strain obtained by speckle tracking echocardiography (STE) can detect subclinical myocardial impairment due to myocardial fibrosis (MF) and is considered a prognostic marker. Aortic stenosis (AS) is not only a valve disease, but also a cardiomyopathy characterized by MF. The purpose of this study was to systematically review and analyze ventricular strain as a predictor of adverse outcomes in patients with AS undergoing transcatheter aortic valve replacement (TAVR).
PubMed, Embase, and the Cochrane library were searched for studies that investigated the prognostic value of impaired ventricular strain on patients with AS undergoing TAVR with all-cause mortality (ACM) and major adverse cardiovascular events (MACE). Pooled odds ratios (ORs), hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated to assess the role of left (LVLS) and right (RVLS) ventricular longitudinal strain in the prognostic prediction of patients with AS undergoing TAVR. Sensitivity and subgroup analysis was performed to assess heterogeneity.
Twelve studies were retrieved from 571 citations for analysis. In total, 1,489 patients with a mean age of 82 years and follow-up periods varying between 1 year and 8.5 years were included. Meta-analysis showed the impaired LVLS from eight studies was associated with an increased risk for combined ACM and MACE (OR: 1.08, 95% CI: 1-1.16; = 0.037), and ACM alone (HR: 1.08, 95% CI: 1.01-1.16; = 0.032). Impaired RVLS from four studies was associated with an increased risk of combined ACM and MACE (OR: 1.08, 95% CI: 1.02-1.14; < 0.01), and ACM alone (HR: 1.07, 95% CI: 1.02-1.12; < 0.01).
This meta-analysis demonstrated that ventricular strain, including LVLS and RVLS, had a substantial prognostic value in ACM or combined ACM and MACE, which could be used as a valid marker for risk stratification in patients with AS undergoing TAVR.
通过斑点追踪超声心动图（STE）获得的应变可检测出因心肌纤维化（MF）导致的亚临床心肌损伤，并被视为一种预后标志物。主动脉瓣狭窄（AS）不仅是一种瓣膜疾病，也是一种以MF为特征的心肌病。本研究的目的是系统评价和分析心室应变作为接受经导管主动脉瓣置换术（TAVR）的AS患者不良结局预测指标的价值。
检索PubMed、Embase和Cochrane图书馆，查找研究心室应变受损对接受TAVR的AS患者全因死亡率（ACM）和主要不良心血管事件（MACE）预后价值的研究。计算合并比值比（OR）、风险比（HR）和95%置信区间（CI），以评估左心室纵向应变（LVLS）和右心室纵向应变（RVLS）在接受TAVR的AS患者预后预测中的作用。进行敏感性和亚组分析以评估异质性。
从571篇文献中检索出12项研究进行分析。总共纳入了1489例患者，平均年龄82岁，随访时间为1年至8.5年。荟萃分析显示，八项研究中LVLS受损与ACM和MACE联合风险增加相关（OR：1.08，95%CI：1 - 1.16；P = 0.037），以及单独的ACM风险增加相关（HR：1.08，95%CI：1.01 - 1.16；P = 0.032）。四项研究中RVLS受损与ACM和MACE联合风险增加相关（OR：1.08，95%CI：1.02 - 1.14；P < 0.01），以及单独的ACM风险增加相关（HR：1.07，95%CI：1.02 - 1.12；P < 0.01）。
这项荟萃分析表明，包括LVLS和RVLS在内的心室应变在ACM或ACM与MACE联合方面具有显著的预后价值，可作为接受TAVR的AS患者风险分层的有效标志物。
