Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy.
High Blood Press Cardiovasc Prev. 2024 Sep;31(5):451-459. doi: 10.1007/s40292-024-00667-9. Epub 2024 Sep 7.
Evidence on myocardial deformation, detected by speckle tracking echocardiography (STE), in patients with acromegaly is scanty.
The aim of the present meta-analysis was to provide an updated information on left ventricular (LV) systolic function assessed by global longitudinal strain (GLS) in patients with acromegaly and preserved LVEF.
Following the PRISMA guidelines, systematic searches were conducted across bibliographic databases (Pub-Med, OVID, EMBASE and Cochrane library) to identify eligible studies from inception up to June 30-2024. Clinical studies published in English reporting data on LV mechanics in patients with acromegaly and controls were included. The statistical difference of the echocardiographic variables of interest between groups such as LVEF and global longitudinal strain (GLS) was calculated by standardized mean difference (SMD) with 95% confidence interval (CI) by using random-effects models.
Seven studies including 288 patients with acromegaly and 294 healthy individuals were considered for the analysis. Pooled average LVEF values were 64.6 ± 1.5% in the healthy control group and 64.0 ± 1.3% in the acromegaly group (SMD: - 0.21 ± 0.22, CI -0.62/0.22, p = 0.34); the corresponding values of GLS were - 19.1.1 ± 1.2% and - 17.5 ± 1.2% (SMD: -0.52 ± 0.27, CI - 1.05/0.01, p = 0.05). No difference was found between the two groups for both global circumferential strain (GCS) and global radial strain (GRS).
Our findings suggest that patients with acromegaly in which LVEF is completely comparable to healthy controls show an impairment in GLS of borderline statistical significance. Whether GLS assessment can actually unmask early alterations of systolic function in patients with acromegaly better than LVEF will need to be investigated by future studies.
关于肢端肥大症患者心肌变形的证据，通过斑点追踪超声心动图（STE）检测，仍然较少。
本荟萃分析的目的是提供关于左心室（LV）整体纵向应变（GLS）评估的最新信息，以评估肢端肥大症患者和保留 LVEF 患者的左心室收缩功能。
根据 PRISMA 指南，对文献数据库（Pub-Med、OVID、EMBASE 和 Cochrane 图书馆）进行系统检索，以从最初到 2024 年 6 月 30 日期间识别出符合条件的研究。纳入了发表在英语文献中，报道了肢端肥大症患者和对照组患者 LV 力学数据的临床研究。使用随机效应模型计算组间感兴趣的超声心动图变量（如 LVEF 和 GLS）的差异，使用标准化均数差（SMD）和 95%置信区间（CI）。
纳入了 7 项研究，包括 288 例肢端肥大症患者和 294 名健康个体。健康对照组的平均 LVEF 值为 64.6±1.5%，肢端肥大症组为 64.0±1.3%（SMD：-0.21±0.22，CI-0.62/0.22，p=0.34）；相应的 GLS 值分别为-19.1.1±1.2%和-17.5±1.2%（SMD：-0.52±0.27，CI-1.05/0.01，p=0.05）。两组的整体圆周应变（GCS）和整体径向应变（GRS）均无差异。
我们的研究结果表明，在 LVEF 完全与健康对照组可比的肢端肥大症患者中，GLS 出现了具有边缘统计学意义的损害。GLS 评估是否实际上比 LVEF 更能揭示肢端肥大症患者早期收缩功能的改变，还需要进一步的研究。
