肥胖患者左心室收缩功能障碍：斑点追踪超声心动图研究的荟萃分析。

Left ventricular systolic dysfunction in obesity: a meta-analysis of speckle tracking echocardiographic studies.

机构信息

Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico.

Department of Clinical Sciences and Community Health, University of Milano.

出版信息

J Hypertens. 2024 Aug 1;42(8):1449-1459. doi: 10.1097/HJH.0000000000003761. Epub 2024 May 20.

DOI:10.1097/HJH.0000000000003761

PMID:38780168

Abstract

BACKGROUND

Obesity is a risk factor for left ventricular hypertrophy (LVH) and diastolic dysfunction. Available evidence on impaired myocardial deformation in obese patients without apparent systolic dysfunction assessed by LV ejection fraction (LVEF) is based on single studies. The aim of the present meta-analysis was to provide a comprehensive and updated information on this issue.

METHODS

The PubMed, OVID-MEDLINE, and Cochrane library databases were analysed to search English-language articles published from the inception up to 31 December 2023. Studies were identified by using MeSH terms and crossing the following search items: ' myocardial strain', 'left ventricular mechanics', 'longitudinal global strain', 'speckle tracking echocardiography', 'systolic dysfunction', 'left ventricular ejection fraction', and 'obesity'.

RESULTS

Twenty-four studies including 5792 obese and 5518 nonobese individuals from different clinical settings were considered for the analysis. LV global longitudinal strain (GLS) was significantly impaired in the obese group [standard means difference (SMD): -0.86 ± 0.08; confidence interval (CI) -1.02 to -0.69, P < 0.0001] and this was paralleled by a significant difference in pooled LVEF between obese and controls (SMD -0.27 ± 0.06; CI -0.40 to -0.15, P < 0.0001). Unlike GLS, however, the majority of the selected studies failed to show statistically significant differences in LVEF. Furthermore, in patients with advanced obesity (BMI > 35 kg/m 2 , data from six studies), LV systolic dysfunction was more significantly detected by GLS (SMD -1.24 ± 0.19, CI -1.61/-0.87, P < 0.0001) than by LVEF (SMD -0.54 ± 0.27, CI -1.07 to -0.01, P = 0.046).

CONCLUSION

The present meta-analysis suggests that GLS may unmask systolic dysfunction often undetected by conventional LVEF in the obese setting; thus, this parameter should be incorporated into routine work-up aimed to identify obesity-mediated subclinical cardiac damage.

摘要

背景

肥胖是左心室肥厚（LVH）和舒张功能障碍的一个危险因素。现有证据表明，在通过左心室射血分数（LVEF）评估没有明显收缩功能障碍的肥胖患者中，心肌变形受损，但这些证据仅基于单篇研究。本荟萃分析的目的是提供关于这一问题的综合和最新信息。

方法

分析了 PubMed、OVID-MEDLINE 和 Cochrane 图书馆数据库，以检索从成立到 2023 年 12 月 31 日发表的英文文章。使用 MeSH 术语和交叉搜索以下项目来确定研究：“心肌应变”、“左心室力学”、“纵向整体应变”、“斑点追踪超声心动图”、“收缩功能障碍”、“左心室射血分数”和“肥胖”。

结果

共纳入 24 项研究，涉及来自不同临床环境的 5792 名肥胖者和 5518 名非肥胖者。肥胖组的左心室整体纵向应变（GLS）明显受损[标准均数差（SMD）：-0.86±0.08；置信区间（CI）：-1.02 至-0.69，P<0.0001]，且肥胖组和对照组之间的 LVEF 也存在显著差异（SMD：-0.27±0.06；CI：-0.40 至-0.15，P<0.0001）。然而，与 GLS 不同的是，大多数选定的研究未能显示 LVEF 有统计学意义的差异。此外，在肥胖程度较重的患者中（BMI>35kg/m2，来自 6 项研究的数据），GLS 比 LVEF 更能显著检测到左心室收缩功能障碍（SMD：-1.24±0.19，CI：-1.61/-0.87，P<0.0001）。