Kitano Tetsuji, Bartoš František, Nabeshima Yosuke, Sayour Alex Ali, Kovács Attila, Takeuchi Masaaki
Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan; Department of Clinical Training and Career Support Center, Mie University Hospital, Tsu, Japan.
Department of Psychological Methods, University of Amsterdam, Amsterdam, Netherlands.
J Cardiovasc Magn Reson. 2024;26(2):101118. doi: 10.1016/j.jocmr.2024.101118. Epub 2024 Oct 28.
There are few meta-analyses examining the prognostic value of right ventricular ejection fraction (RVEF) for a specific type of cardiovascular disease (CVD). The aim of this study was to compare the association of cardiac magnetic resonance (CMR)-derived RVEF with adverse outcomes for several specific types of CVD, using a robust Bayesian model-averaged meta-analysis.
Three databases were searched for CMR articles reporting hazard ratios (HRs) of RVEF restricted to a specific type of CVD. For each specific type of CVD, Bayesian model-averaged meta-analyses with and without publication bias adjustments were conducted to evaluate the strength of evidence for RVEF according to the Bayes factor (BF).
Among 108 articles (21,166 patients) analyzing 11 CVD types, pooled HR for 5% reduction in RVEF assessed by publication bias-unadjusted, Bayesian model-averaged meta-analysis offered moderate or strong evidence of an association with outcomes for all types of CVD (HR: 1.07-1.37, BF: 4.3-9.6 * 10). In contrast, a robust Bayesian model-averaged meta-analysis, adjusted for publication bias, found moderate or strong evidence in favor of an association of RVEF with outcomes only in hypertrophic cardiomyopathy (HR: 1.19, 95% credible interval (CrI): 0.98-1.42, BF: 5.0), dilated cardiomyopathy (HR: 1.16, 95% CrI: 1-1.22, BF: 23.3), pulmonary hypertension (HR: 1.05, 95% CrI: 1-1.12, BF: 3.0), and aortic stenosis (HR: 1.15, 95% CrI: 0.97-1.34, BF: 4.2). There was weak evidence for an association of RVEF with adverse outcomes in seven other CVDs.
In a Bayesian meta-analysis adjusted for publication bias, there was moderate or strong evidence for an association of RVEF with outcomes for only four CVDs. Additional data may strengthen evidence regarding other CVDs.
很少有荟萃分析研究右心室射血分数（RVEF）对特定类型心血管疾病（CVD）的预后价值。本研究的目的是使用稳健的贝叶斯模型平均荟萃分析，比较心脏磁共振成像（CMR）得出的RVEF与几种特定类型CVD不良结局之间的关联。
检索三个数据库，查找报告限于特定类型CVD的RVEF风险比（HR）的CMR文章。对于每种特定类型的CVD，进行有无发表偏倚调整的贝叶斯模型平均荟萃分析，以根据贝叶斯因子（BF）评估RVEF的证据强度。
在分析11种CVD类型的108篇文章（21166例患者）中，通过未调整发表偏倚的贝叶斯模型平均荟萃分析评估，RVEF降低5%的合并HR为所有类型的CVD提供了中度或强证据表明其与结局相关（HR：1.07 - 1.37，BF：4.3 - 9.6×10）。相比之下，经过发表偏倚调整的稳健贝叶斯模型平均荟萃分析发现，仅在肥厚型心肌病（HR：1.19，95%可信区间（CrI）：0.98 - 1.42，BF：5.0）、扩张型心肌病（HR：1.16，95% CrI：1 - 1.22，BF：23.3）、肺动脉高压（HR：1.05，95% CrI：1 - 1.12，BF：3.0）和主动脉瓣狭窄（HR：1.15，95% CrI：0.97 - 1.34，BF：4.2）中有中度或强证据支持RVEF与结局相关。在其他七种CVD中，RVEF与不良结局相关的证据较弱。
在经过发表偏倚调整的贝叶斯荟萃分析中，只有四种CVD有中度或强证据表明RVEF与结局相关。更多数据可能会加强关于其他CVD的证据。
