Vascular Health in Congenital Heart Disease: A Systematic Review and Meta-Analysis.

IF 5.8 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Juliana Lasso-Mendez, Christopher Spence, Lisa K Hornberger, Allison Sivak, Margie H Davenport
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引用次数: 0

Abstract

Background: Congenital heart disease (CHD) affects 1% of live births and is a risk factors for cardiovascular disease and reduced life expectancy. Previous studies have suggested CHD is associated with impaired vascular health, but this has not been established. Therefore, the objective of this study was to examine the impact of congenital heart disease (CHD) on vascular health.

Methods: Eight electronic databases were searched through April 12, 2024. Studies of all designs (except case studies and reviews) which reported on the population (individuals with CHD of any age), comparator (individuals without CHD), and outcomes of interest: endothelial dependent (flow-mediated vasodilation [FMD%], reactive hyperemia index [RHI]) and independent (nitroglycerine mediated dilation [NMD%]) vascular function, arterial stiffness (pulse-wave velocity [PWV], stiffness index [SI], augmentation index [AIx], distensibility and compliance), and carotid intima-media thickness (cIMT) were included. Results are presented as standardized mean differences and 95% confidence intervals and by effect size.

Results: 138 studies (N=16,115) were included in the meta-analysis. Individuals with CHD exhibited decreased vascular function compared to those without including decreased FMD% -0.96, 95% CI: -1.22, -0.70, I2= 85%, large effect size), RHI by ultrasound -2.88, 95% CI: -4.85, -0.90, I2 =96%, large effect size), and NMD% -0.98; 95% CI: -1.35, -0.61, I2= 87%, large effect size). Various CHD subtypes including, coarctation of the aorta, transposition of the great arteries, tetralogy of Fallot, post-Fontan showed significant vascular dysfunction. Shunt lesions did not show significant vascular dysfunction.

Conclusion: CHD is associated with vascular dysfunction, increased arterial stiffness and greater cIMT in both pediatric and adult patients. PROSPERO registration number: CRD42022369180.

先天性心脏病患者的血管健康:系统回顾与元分析》。
背景:先天性心脏病(CHD)影响着1%的活产婴儿,是心血管疾病和预期寿命缩短的风险因素。以往的研究表明,先天性心脏病与血管健康受损有关,但这一点尚未得到证实。因此,本研究旨在探讨先天性心脏病(CHD)对血管健康的影响:方法:检索了截至 2024 年 4 月 12 日的 8 个电子数据库。所有设计的研究(病例研究和综述除外)均报告了相关人群(任何年龄段的先天性心脏病患者)、参照物(无先天性心脏病患者)和结果:包括内皮依赖性(血流介导的血管扩张[FMD%]、反应性充血指数[RHI])和独立性(硝酸甘油介导的血管扩张[NMD%])血管功能、动脉僵化(脉搏波速度[PWV]、僵化指数[SI]、增强指数[AIx]、扩张性和顺应性)以及颈动脉内膜中层厚度(cIMT)。结果以标准化均值差异、95% 置信区间和效应大小表示:荟萃分析共纳入 138 项研究(N=16,115)。与非冠心病患者相比,冠心病患者的血管功能有所下降,包括 FMD% -0.96,95% CI:-1.22,-0.70,I2=85%,大效应)、超声波 RHI -2.88,95% CI:-4.85,-0.90,I2=96%,大效应)和 NMD% -0.98;95% CI:-1.35,-0.61,I2=87%,大效应)。主动脉共动脉瘤、大动脉转位、法洛氏四联症、后方坦等各种先天性心脏病亚型均显示出明显的血管功能障碍。分流病变未显示出明显的血管功能障碍:结论:无论是儿童还是成人,心脏畸形都与血管功能障碍、动脉僵化增加和 cIMT 增大有关。PROSPERO 注册号CRD42022369180。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Canadian Journal of Cardiology
Canadian Journal of Cardiology 医学-心血管系统
CiteScore
9.20
自引率
8.10%
发文量
546
审稿时长
32 days
期刊介绍: The Canadian Journal of Cardiology (CJC) is the official journal of the Canadian Cardiovascular Society (CCS). The CJC is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as the major venue for Canadian cardiovascular medicine.
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