Ni Jin-Rong, Xin Wen-Long, Hu Yuan, Liu Shi-Dong, Li Jin-Kui, Wan Zun-Hui, Lei Jun-Qiang
The First Hospital (First Clinical Medical School) of Lanzhou University, 730000 Lanzhou, Gansu, China.
Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, 730000 Lanzhou, Gansu, China.
Rev Cardiovasc Med. 2023 Dec 25;24(12):359. doi: 10.31083/j.rcm2412359. eCollection 2023 Dec.
Chronic aortic regurgitation (AR) is a common valvular disease characterized by an overload of left ventricular volume and pressure. Accurate assessment of the heart from all angles is crucial for effective clinical management and prognostic evaluation of AR patients. As an advanced imaging technique, cardiac magnetic resonance (CMR) has become the gold standard for assessing cardiac volume and function. Accordingly, this study aimed to evaluate the prognostic value of CMR in chronic AR.
EMBASE, Cochrane Library, PubMed, and Web of Science were searched for clinical studies published between inception and July 19, 2022. Only studies that used CMR to assess patients with chronic isolated AR and provided prognostic data were included.
For our analysis, 11 studies, which involved 1702 subjects and follow-up periods of 0.6-9.7 years, were eligible. We identified 13 CMR-related parameters associated with AR prognosis. With aortic valve surgery as the outcome, we estimated the pooled hazard ratios (HRs) for four of these parameters: aortic regurgitation fraction (ARF), aortic regurgitation volume (ARV), left ventricle end-diastolic volume (LVEDV), and LV end-systolic volume (LVESV). The pooled HR for ARF was found to be 4.31 (95% confidence interval [CI]: 1.12-16.59, = 0.034), while that for ARV was 3.88 (95% CI: 0.71-21.04, = 0.116). Additionally, the combined HRs of LVEDV and LVESV were estimated to be 2.20 (95% CI: 1.04-4.67, = 0.039) and 3.14 (95% CI: 1.22-8.07, = 0.018), respectively.
The assessment of ARF, LVEDV, and LVESV via CMR has significant prognostic value in predicting the prognosis of AR patients with aortic valve surgery as an endpoint. It is recommended to consider using multi-parameter CMR in the clinical management of AR patients for timely interventions and effective prognostic evaluation.
慢性主动脉瓣反流（AR）是一种常见的瓣膜疾病，其特征是左心室容量和压力过载。从各个角度准确评估心脏对于AR患者的有效临床管理和预后评估至关重要。作为一种先进的成像技术，心脏磁共振成像（CMR）已成为评估心脏容量和功能的金标准。因此，本研究旨在评估CMR在慢性AR中的预后价值。
检索了EMBASE、Cochrane图书馆、PubMed和Web of Science中自数据库建立至2022年7月19日发表的临床研究。仅纳入使用CMR评估慢性孤立性AR患者并提供预后数据的研究。
纳入分析的有11项研究，涉及1702名受试者，随访时间为0.6 - 9.7年。我们确定了13个与AR预后相关的CMR参数。以主动脉瓣手术为结局，我们估计了其中4个参数的合并风险比（HR）：主动脉反流分数（ARF）、主动脉反流容积（ARV）、左心室舒张末期容积（LVEDV）和左心室收缩末期容积（LVESV）。发现ARF的合并HR为4.31（95%置信区间[CI]：1.12 - 16.59，P = 0.034），而ARV的合并HR为3.88（95%CI：0.71 - 21.04，P = 0.116）。此外，LVEDV和LVESV的合并HR估计分别为2.20（95%CI：1.04 - 4.67，P = 0.039）和3.14（95%CI：1.22 - 8.07，P = 0.018）。
通过CMR评估ARF、LVEDV和LVESV在以主动脉瓣手术为终点预测AR患者的预后方面具有显著的预后价值。建议在AR患者的临床管理中考虑使用多参数CMR进行及时干预和有效的预后评估。
