Department of Cardiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, China.
Sichuan Clinical Research Center for Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, China.
Am J Hypertens. 2024 Jan 16;37(2):134-142. doi: 10.1093/ajh/hpad089.
This study aimed to explore the effectiveness of intraprocedural cortisol measurement (IPCM) for the technical success rates of bilateral adrenal vein, right adrenal vein (RAV), and left adrenal vein (LAV) cannulation during adrenal vein sampling (AVS).
Systematic searches of PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were performed from database inception to May 10, 2023, without any restrictions. We estimated the overall effect estimates of outcomes using the Mantel-Haenszel random-effects model. We conducted subgroup analyses, meta-regression, and sensitivity analysis to explore the possible sources of between-study heterogeneity.
In total, 3,485 patients from 11 studies (three prospective and eight retrospective) were enrolled. Bilateral selectivity in patients who underwent IPCM during AVS was significantly higher than that in patients who underwent a routine AVS procedure (84% vs. 64%, RR 1.42, 95% confidence interval [CI]: 1.27-1.59, P < 0.01), with significant heterogeneity (I2 = 68%). A 42% relative risk reduction in the failure rate of bilateral adrenal vein cannulation was found in the IPCM group. Moreover, pooled analysis showed a significant increase in the success rates of RAV cannulation (84% vs. 72%, RR 1.21, 95% CI 1.12-1.31, P < 0.01, I2 = 33%) and LAV cannulation (89% vs. 84%, RR 1.05, 95% CI 1.02-1.08, P < 0.01, I2 = 4%) when IPCM was implemented during the AVS procedure compared to the routine AVS procedure.
An IPCM-based strategy during AVS appears to have a significant beneficial effect on improving the success rate of bilateral cannulation, RAV cannulation and LAV cannulation.
本研究旨在探讨术中皮质醇测量（IPCM）对双侧肾上腺静脉、右肾上腺静脉（RAV）和左肾上腺静脉（LAV）在肾上腺静脉采样（AVS）期间插管技术成功率的影响。
系统检索了 PubMed、Embase、Cochrane 图书馆和 ClinicalTrials.gov 数据库，检索时间截至 2023 年 5 月 10 日，无任何限制。我们使用 Mantel-Haenszel 随机效应模型估计了结局的总体效应估计值。我们进行了亚组分析、meta 回归和敏感性分析，以探讨研究间异质性的可能来源。
共有 11 项研究（3 项前瞻性研究和 8 项回顾性研究）的 3485 例患者纳入本研究。在接受 AVS 期间行 IPCM 的患者双侧选择性明显高于行常规 AVS 手术的患者（84% vs. 64%，RR 1.42，95%置信区间 [CI]：1.27-1.59，P<0.01），存在显著异质性（I2=68%）。在 IPCM 组，双侧肾上腺静脉插管失败率相对降低 42%。此外，汇总分析显示，RAV 插管成功率显著提高（84% vs. 72%，RR 1.21，95%CI 1.12-1.31，P<0.01，I2=33%）和 LAV 插管成功率（89% vs. 84%，RR 1.05，95%CI 1.02-1.08，P<0.01，I2=4%），当在 AVS 期间采用 IPCM 时，与常规 AVS 相比。
AVS 期间基于 IPCM 的策略似乎对提高双侧插管、RAV 插管和 LAV 插管成功率具有显著的有益效果。
