Sonaglioni Andrea, Caminati Antonella, Nicolosi Gian Luigi, Muti-Schünemann Giovanna Elsa Ute, Lombardo Michele, Harari Sergio
Division of Cardiology, IRCCS MultiMedica, 20123 Milan, Italy.
Semi-Intensive Care Unit, Division of Pneumology, IRCCS MultiMedica, 20123 Milan, Italy.
J Clin Med. 2025 Jan 22;14(3):714. doi: 10.3390/jcm14030714.
Over the last few years, a few imaging studies have performed conventional transthoracic echocardiography (TTE) implemented with speckle tracking echocardiography (STE) for the assessment of biventricular mechanics in patients with non-advanced idiopathic pulmonary fibrosis (IPF). This systematic review and meta-analysis aimed at evaluating the overall effect of mild-to-moderate IPF on the main indices of biventricular systolic function assessed by TTE and STE. All imaging studies assessing right ventricular (RV)-global longitudinal strain (GLS), left ventricular (LV)-GLS, tricuspid annular plane systolic excursion (TAPSE), and left ventricular ejection fraction (LVEF) in IPF patients vs. healthy controls, selected from PubMed, Scopus, and EMBASE databases, were included. Continuous data (RV-GLS, LV-GLS, TAPSE, and LVEF) were pooled as standardized mean differences (SMDs) comparing the IPF group with healthy controls. The SMD of RV-GLS was calculated using the random-effect model, whereas the SMDs of LV-GLS, TAPSE, and LVEF were calculated using the fixed-effect model. The full texts of 6 studies with 255 IPF patients and 195 healthy controls were analyzed. Despite preserved TAPSE and LVEF, both RV-GLS and LV-GLS were significantly, although modestly, reduced in the IPF patients vs. the controls. The SMD was large (-1.01, 95% CI -1.47, -0.54, < 0.001) for RV-GLS, medium (-0.62, 95% CI -0.82, -0.42, < 0.001) for LV-GLS, small (-0.42, 95% CI -0.61, -0.23, < 0.001) for TAPSE, and small and not statistically significant (-0.20, 95% CI -0.42, 0.03, = 0.09) for LVEF assessment. Between-study heterogeneity was high for the studies assessing RV-GLS (I = 80.5%), low-to-moderate for those evaluating LV-GLS (I = 41.7%), and low for those measuring TAPSE (I = 16.4%) and LVEF (I = 7.63%). The Egger's test yielded a -value of 0.60, 0.11, 0.31, and 0.68 for the RV-GLS, LV-GLS, TAPSE, and LVEF assessment, respectively, indicating no publication bias. On meta-regression analysis, none of the moderators was significantly associated with effect modification for RV-GLS (all > 0.05). The sensitivity analysis supported the robustness of the results. RV-GLS impairment is an early marker of subclinical myocardial dysfunction in mild-to-moderate IPF. STE should be considered for implementation in clinical practice for early detection of RV dysfunction in IPF patients without advanced lung disease.
在过去几年中，一些影像学研究采用斑点追踪超声心动图（STE）辅助传统经胸超声心动图（TTE），对非晚期特发性肺纤维化（IPF）患者的双心室力学进行评估。本系统评价和荟萃分析旨在评估轻至中度IPF对通过TTE和STE评估的双心室收缩功能主要指标的总体影响。纳入了从PubMed、Scopus和EMBASE数据库中选取的，评估IPF患者与健康对照者右心室（RV）整体纵向应变（GLS）、左心室（LV）-GLS、三尖瓣环平面收缩期位移（TAPSE）和左心室射血分数（LVEF）的所有影像学研究。连续数据（RV-GLS、LV-GLS、TAPSE和LVEF）合并为标准化均数差（SMD），用于比较IPF组与健康对照。RV-GLS的SMD采用随机效应模型计算，而LV-GLS、TAPSE和LVEF的SMD采用固定效应模型计算。对6项研究的全文进行了分析，这些研究共纳入255例IPF患者和195例健康对照。尽管TAPSE和LVEF保持正常，但与对照组相比，IPF患者的RV-GLS和LV-GLS均显著降低，不过降低幅度较小。RV-GLS的SMD较大（-1.01，95%CI -1.47，-0.54，<0.001），LV-GLS的SMD中等（-0.62，95%CI -0.82，-0.42，<0.001），TAPSE的SMD较小（-0.42，95%CI -0.61，-0.23，<0.001），LVEF评估的SMD较小且无统计学意义（-0.20，95%CI -0.42，0.03，P=0.09）。评估RV-GLS的研究间异质性较高（I²=80.5%），评估LV-GLS的研究异质性为低至中度（I²=41.7%），测量TAPSE（I²=16.4%）和LVEF（I²=7.63%）的研究异质性较低。Egger检验显示，RV-GLS、LV-GLS、TAPSE和LVEF评估的P值分别为0.60、0.11、0.31和0.68，表明无发表偏倚。在Meta回归分析中，没有一个调节因素与RV-GLS的效应修饰显著相关（所有P>0.05）。敏感性分析支持结果的稳健性。RV-GLS受损是轻至中度IPF亚临床心肌功能障碍的早期标志物。对于未患有晚期肺部疾病的IPF患者，临床实践中应考虑采用STE早期检测RV功能障碍。
