Soares Caroline Almeida, Fiuza João Gouveia, Rodrigues Cláudio André Melo, Craveiro Nuno, Gil Pereira Júlio, Sousa Paula Cristina Ribeiro Fernandes, Martins Diana Catarina Pinto, Cancela Eugénia Maria, Ministro Dos Santos Maria Paula
Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, E.P.E., Av. Rei D. Duarte, Viseu 3504-509, Portugal.
Cardiology Department, Unidade Local de Saúde de Viseu Dão Lafões, Viseu, Portugal.
Therap Adv Gastroenterol. 2024 Dec 16;17:17562848241299534. doi: 10.1177/17562848241299534. eCollection 2024.
Morphological and functional cardiac involvement is rarely described in patients with inflammatory bowel disease (IBD) but there is evidence that they have an increased risk of cardiovascular (CV) events despite the lower prevalence of traditional CV risk factors.
Our systematic review and meta-analysis examined the relationship between IBD and cardiac function, namely the incidence of heart failure (HF) and subclinical echocardiographic changes.
Two medical databases, PubMed and Scopus, were systematically searched up to September 2022 to identify all studies reporting HF and/or echocardiographic changes in IBD patients.
The qualitative analysis comprised a total of 18 studies (14 retrospective and 4 prospective studies) involving 59,838 patients. IBD was associated with subtle systolic and diastolic alterations, vascular dysfunction, increased risk for HF hospitalizations, and globally worse CV outcomes. Nine studies were included in the meta-analysis. In the IBD population, we found statistically significant reduced early to late diastolic transmitral flow (E/A), higher E to early diastolic mitral annular tissue velocity (E/e'), and decreased global longitudinal strain. Increased left atrial diameter and area were also present in IBD patients but no statistical significance was reached. Inter-atrial and right intra-atrial conduction delays were observed.
The IBD population has an increased risk for left ventricular and atrial dysfunction, vascular changes, arrhythmias, and HF hospitalization. Screening with sensitive imaging like speckle tracking echocardiography could identify early subclinical changes. IBD is in fact a CV risk factor and tight inflammation control may reduce CV risk.
炎症性肠病（IBD）患者很少出现心脏形态和功能受累的情况，但有证据表明，尽管传统心血管风险因素的患病率较低，但他们发生心血管（CV）事件的风险增加。
我们的系统评价和荟萃分析研究了IBD与心脏功能之间的关系，即心力衰竭（HF）的发生率和亚临床超声心动图改变。
系统检索了两个医学数据库PubMed和Scopus，截至2022年9月，以识别所有报告IBD患者HF和/或超声心动图改变的研究。
定性分析共纳入18项研究（14项回顾性研究和4项前瞻性研究），涉及59838例患者。IBD与轻微的收缩期和舒张期改变、血管功能障碍、HF住院风险增加以及总体较差的CV结局相关。荟萃分析纳入了9项研究。在IBD人群中，我们发现舒张早期至晚期二尖瓣血流（E/A）显著降低、E与舒张早期二尖瓣环组织速度（E/e'）比值升高以及整体纵向应变降低。IBD患者左心房直径和面积也增加，但未达到统计学显著性。观察到心房内和右心房间传导延迟。
IBD人群发生左心室和心房功能障碍、血管改变、心律失常以及HF住院的风险增加。使用斑点追踪超声心动图等敏感成像技术进行筛查可以识别早期亚临床改变。事实上，IBD是一种CV风险因素，严格控制炎症可能会降低CV风险。
