Sonaglioni Andrea, Torretta Priscilla, Nicolosi Gian L, Lombardo Michele
Division of Cardiology, MultiMedica IRCCS, Milan, Italy -
Division of Cardiology, MultiMedica IRCCS, Milan, Italy.
Minerva Cardiol Angiol. 2025 Mar 19. doi: 10.23736/S2724-5683.24.06683-3.
Over the last decade, a small number of studies have used speckle tracking echocardiography (STE) or cardiac magnetic resonance (CMR) for measuring left ventricular (LV) mechanics in patients with amyloidosis. This systematic review and meta-analysis aimed at assessing the overall influence of amyloidosis on LV global longitudinal strain (GLS) and regional longitudinal strain at basal (BLS), mid (MLS) and apical (ALS) level, respectively.
All imaging studies assessing LV-GLS, LV-BLS, LV-MLS and LV-ALS in amyloidosis patients versus healthy controls, selected from PubMed and EMBASE databases, were included. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment of Case-Control Studies. Continuous data (LV-GLS, LV-BLS, LV-MLS and LV-ALS) were pooled as a standardized mean differences (SMDs) comparing amyloidosis group with healthy controls. The overall SMDs of LV-GLS, LV-BLS, LV-MLS and LV-ALS were calculated using the random-effect model.
The full-texts of 13 studies with 553 amyloidosis patients and 575 healthy controls were analyzed. STE (53.8%) and CMR (46.2%) studies were separately analyzed. Average LV-GLS magnitude was significantly impaired in amyloidosis patients vs. controls in both STE (13.8±3.9 vs. 19.8±2.7%) and CMR (12.3±4 vs. 17.9±3.5%) studies. The impairment of segmental strain detected in amyloidosis patients was prevalent at basal and mid level, with relative "apical sparing." SMDs obtained for LV-GLS (SMD -1.80, 95% CI: -2.35, -1.24, P <0.001), LV-BLS (-1.98; 95% CI: -2.51, -1.45, P <0.001) and LV-MLS (-1.84; 95% CI: -2.46, -1.23, P <0.001) assessment were significantly larger than that obtained for LV-ALS (-0.72; 95% CI: -1.31, -0.13, P=0.02) measurement. Substantial heterogeneity was found among the studies assessing LV-GLS (I=92.5%), LV-BLS (I=91.4%), LV-MLS (I=94.3%) and LV-ALS (I=94.6%). Egger's test yielded a P value of 0.10, 0.20, 0.09 and 0.55 for LV-GLS, LV-BLS, LV-MLS and LV-ALS assessment respectively, indicating no publication bias. On meta-regression analysis, none of the moderators was significantly associated with effect modification for LV-GLS, LV-BLS, LV-MLS and LV-ALS (all P<0.05).
Amyloidosis has a large negative effect on LV-GLS, primarily related to the deterioration of segmental longitudinal strain at the basal and mid level, with relative apical sparing.
在过去十年中，少数研究使用斑点追踪超声心动图（STE）或心脏磁共振成像（CMR）来测量淀粉样变性患者的左心室（LV）力学。本系统评价和荟萃分析旨在评估淀粉样变性分别对左心室整体纵向应变（GLS）以及基底（BLS）、中间（MLS）和心尖（ALS）水平的区域纵向应变的总体影响。
纳入所有从PubMed和EMBASE数据库中选取的评估淀粉样变性患者与健康对照者左心室GLS、左心室BLS、左心室MLS和左心室ALS的影像学研究。采用美国国立卫生研究院（NIH）病例对照研究质量评估方法评估偏倚风险。将连续数据（左心室GLS、左心室BLS、左心室MLS和左心室ALS）合并为标准化均数差值（SMD），用于比较淀粉样变性组与健康对照者。使用随机效应模型计算左心室GLS、左心室BLS、左心室MLS和左心室ALS的总体SMD。
对13项研究的全文进行了分析，这些研究共纳入553例淀粉样变性患者和575例健康对照者。分别对STE（53.8%）和CMR（46.2%）研究进行了分析。在STE（13.8±3.9%对19.8±2.7%）和CMR（12.3±4对17.9±3.5%）研究中，淀粉样变性患者的平均左心室GLS幅度与对照组相比均显著受损。淀粉样变性患者中检测到的节段性应变受损在基底和中间水平普遍存在，相对“心尖保留”。左心室GLS（SMD -1.80，95%CI：-2.35，-1.24，P<0.001）、左心室BLS（-1.98；95%CI：-2.51，-1.45，P<0.001）和左心室MLS（-1.84；95%CI：-2.46，-1.23，P<0.001）评估的SMD显著大于左心室ALS（-0.72；95%CI：-1.31，-0.13，P=0.02）测量的SMD。在评估左心室GLS（I=92.5%）、左心室BLS（I=91.4%）、左心室MLS（I=94.3%）和左心室ALS（I=94.6%）的研究中发现了显著的异质性。Egger检验在左心室GLS、左心室BLS、左心室MLS和左心室ALS评估中的P值分别为0.10、0.20、0.09和0.55，表明无发表偏倚。在Meta回归分析中，没有一个调节因素与左心室GLS、左心室BLS、左心室MLS和左心室ALS的效应修饰显著相关（所有P<0.05）。
淀粉样变性对左心室GLS有很大的负面影响，主要与基底和中间水平的节段性纵向应变恶化有关，相对心尖保留。
