Casian Mihnea, Dima Alina, Jurcuț Ciprian, Andrei Laura, Edwards Jamie, O'Driscoll Jamie, Popescu Bogdan A, Jurcuț Ruxandra
University of Medicine and Pharmacy "Carol Davila", Str. Dionisie Lupu 37, Sector 2, 020021, Bucharest, Romania.
Department of Cardiology, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania.
Echo Res Pract. 2025 Jul 14;12(1):18. doi: 10.1186/s44156-025-00081-4.
The study aimed to evaluate differences in conventional, tissue Doppler imaging (TDI) and speckle-tracking echocardiographic (STE) parameters of all cardiac chambers between SSc patients and healthy controls.
A study search strategy based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was performed. MEDLINE, Scopus and Web of Science were searched using the following keywords: "speckle tracking", "global strain", "longitudinal strain", "circumferential strain", "radial strain", "atrial strain", "right ventricular strain", or "left ventricular strain" and "systemic sclerosis". Primary pooled analyses were performed on each cardiac parameter independently to determine the weighted mean difference (WMD) between SSc and controls. Further independent subgroup analyses were performed to compare symptomatic vs asymptomatic SSc and diffuse vs limited SSc.
The systematic review and meta-analysis included 41 case-control eligible reports studies with a pooled sample size of 2497 SSc cases and 1439 controls. Significant weighted mean differences (WMD) between SSc patients and healthy controls were identified in septal S' wave (WMD 0.343 cm/s, CI [- 0.540-0.145], I: 36%, p = 0.001), lateral S' wave (WMD 0.795 cm/s, CI [- 1.394-0.197], I: 0%, p = 0.009), tricuspid S' wave (WMD 1.137 cm/s, CI [- 1.784-0.489], I: 84%, p = 0.001), septal e' wave (WMD 1.398 cm/s, CI [- 2.272-0.523], I: 82%, p = 0.002) and lateral e' wave (WMD 3.545 cm/s, CI [- 4.990-2.100], I: 71%, p < 0.001) velocities. STE parameters were attenuated in patients with SSc, with impairment of left ventricular global longitudinal (WMD 2.765%, CI [- 3.482-2.049], I: 91%, p < 0.001), circumferential (WMD 3.145%, CI [- 4.181-2.109], I: 79%, p < 0.001), and radial (WMD 4.044%, CI [- 6.199-1.889], I: 0%, p < 0.001) strain, right ventricular free wall (WMD 4.492%, CI [- 6.048-2.937], I: 76%, p < 0.001) and right ventricular global longitudinal strain (WMD 2.843%, CI [- 3.290-2.396], I: 32%, p < 0.001), as well as left (WMD - 8.317%, CI [- 11.873-4.761], I: 82%, p < 0.001) and right (WMD 7.346%, CI [- 10.536-4.156], I: 26%, p < 0.001) atrial reservoir strain.
SSc is associated with significantly impaired cardiac function and mechanics compared to healthy individuals, even in the absence of symptoms or pulmonary hypertension.
本研究旨在评估系统性硬化症（SSc）患者与健康对照者之间所有心腔的传统、组织多普勒成像（TDI）和斑点追踪超声心动图（STE）参数的差异。
基于系统评价和Meta分析的首选报告项目（PRISMA）进行研究检索策略。使用以下关键词在MEDLINE、Scopus和科学网中进行检索：“斑点追踪”、“整体应变”、“纵向应变”、“圆周应变”、“径向应变”、“心房应变”、“右心室应变”或“左心室应变”以及“系统性硬化症”。对每个心脏参数独立进行主要合并分析，以确定SSc患者与对照者之间的加权平均差（WMD）。进行进一步的独立亚组分析，以比较有症状与无症状的SSc患者以及弥漫性与局限性SSc患者。
该系统评价和Meta分析纳入了41项符合病例对照研究标准的报告，汇总样本量为2497例SSc病例和1439例对照者。在间隔S'波（WMD 0.343cm/s，CI[-0.540 - 0.145]，I：36%，p = 0.001）、侧壁S'波（WMD 0.795cm/s，CI[-1.394 - 0.197]，I：0%，p = 0.009）、三尖瓣S'波（WMD 1.137cm/s，CI[-1.784 - 0.489]，I：84%，p = 0.001）、间隔e'波（WMD 1.398cm/s，CI[-2.272 - 0.523]，I：82%，p = 0.002）和侧壁e'波（WMD 3.545cm/s，CI[-4.990 - 2.100]，I：71%，p < 0.001）速度方面，确定了SSc患者与健康对照者之间存在显著的加权平均差（WMD）。SSc患者的STE参数减弱，左心室整体纵向应变（WMD 2.765%，CI[-3.482 - 2.049]，I：91%，p < 0.001）、圆周应变（WMD 3.145%，CI[-4.181 - 2.109]，I：79%，p < 0.001）和径向应变（WMD 4.044%，CI[-6.199 - 1.889]，I：0%，p < 0.001）、右心室游离壁（WMD 4.492%，CI[-6.048 - 2.937]，I：76%，p < 0.001）和右心室整体纵向应变（WMD 2.843%，CI[-3.290 - 2.396]，I：32%，p < 0.001）以及左心房（WMD -8.317%，CI[-11.873 - 4.761]，I：82%，p < 0.001）和右心房（WMD 7.346%，CI[-10.536 - 4.156]）储备应变均受损。
与健康个体相比，即使在没有症状或肺动脉高压的情况下，SSc也与心脏功能和力学显著受损相关。
