风湿性心脏病高发地区的常规产前超声心动图检查：世界卫生组织指南系统回顾》。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Global Heart Pub Date : 2024-04-25 eCollection Date: 2024-01-01 DOI:10.5334/gh.1318

Samuel Seitler, Mahmood Ahmad, Sanjali Anil Chu Ahuja, Malik Takreem Ahmed, Alexander Stevenson, Tamar Rachel Schreiber, Prem Singh Sodhi, Hiruna Kojitha Diyasena, Osarumwense Ogbeide, Sankavi Arularooran, Farhad Shokraneh, Miryan Cassandra, Eloi Marijon, David S Celermajer, Mohammed Y Khanji, Rui Providencia

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引用次数: 0

摘要

背景：风湿性心脏病（RHD）是全球最常见的瓣膜性心脏病。未经诊断或治疗的风湿性心脏病会使妊娠复杂化，导致不良的母体和胎儿结局，也是非产科发病率的一个重要因素。超声心动图在筛查 RHD 方面发挥着新的作用。我们旨在批判性地分析超声心动图用于筛查高发地区孕妇 RHD 的证据：我们检索了 MEDLINE 和 Embase，以确定相关报告。方法：我们检索了MEDLINE和Embase，确定了相关报告，两名独立审稿人根据资格标准对报告进行了双盲评估：检索（日期：2023 年 4 月 4 日）发现了 432 条可供筛选的记录。共发现了 10 项非对照观察性研究，其中 5 项使用了便携式或手持式超声心动图，包含 23,166 名女性的数据。各项研究的 RHD 患病率各不相同，从 0.4% 到 6.6% 不等（I2，异质性 >90%）。此外，还发现了其他心脏异常（如先天性心脏病和左心室收缩功能障碍）：超声心动图作为高发地区产前保健的一部分，可检测出无症状孕妇的 RHD 或其他心脏异常，从而降低疾病进展率和与分娩相关的不良后果。然而，由于证据的确定性较低，且缺乏将超声心动图与标准产前护理进行比较的研究，因此这一证据受到了影响：PROSPERO 2022 年 7 月 4 日；CRD42022344081 可查阅：https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=344081.Research 问题："在风湿性心脏病高发地区，是否应在常规产前护理中增加手持式超声心动图检查？

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Routine Antenatal Echocardiography in High-Prevalence Areas of Rheumatic Heart Disease: A WHO-Guideline Systematic Review.

Background: Rheumatic Heart Disease (RHD) is the most common cause of valvular heart disease worldwide. Undiagnosed or untreated RHD can complicate pregnancy and lead to poor maternal and fetal outcomes and is a significant factor in non-obstetric morbidity. Echocardiography has an emerging role in screening for RHD. We aimed to critically analyse the evidence on the use of echocardiography for screening pregnant women for RHD in high-prevalence areas.

Methods: We searched MEDLINE and Embase to identify the relevant reports. Two independent reviewers assessed the reports against the eligibility criteria in a double-blind process.

Results: The searches (date: 4 April 2023) identified 432 records for screening. Ten non-controlled observational studies were identified, five using portable or handheld echocardiography, comprising data from 23,166 women. Prevalence of RHD varied across the studies, ranging from 0.4 to 6.6% (I², heterogeneity >90%). Other cardiac abnormalities (e.g., congenital heart disease and left ventricular systolic dysfunction) were also detected <1% to 2% of cases. Certainty of evidence was very low.

Conclusion: Echocardiography as part of antenatal care in high-prevalence areas may detect RHD or other cardiac abnormalities in asymptomatic pregnant women, potentially reducing the rates of disease progression and adverse labor-associated outcomes. However, this evidence is affected by the low certainty of evidence, and lack of studies comparing echocardiography versus standard antenatal care.

Prospective registration: PROSPERO 2022 July 4; CRD42022344081 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=344081.

Research question: 'In areas with a high prevalence of rheumatic heart disease, should handheld echocardiography be added to routine antenatal care?'

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来源期刊

Global Heart Medicine-Cardiology and Cardiovascular Medicine

CiteScore

5.70

自引率

5.40%

发文量

审稿时长

5 weeks

期刊介绍： Global Heart offers a forum for dialogue and education on research, developments, trends, solutions and public health programs related to the prevention and control of cardiovascular diseases (CVDs) worldwide, with a special focus on low- and middle-income countries (LMICs). Manuscripts should address not only the extent or epidemiology of the problem, but also describe interventions to effectively control and prevent CVDs and the underlying factors. The emphasis should be on approaches applicable in settings with limited resources. Economic evaluations of successful interventions are particularly welcome. We will also consider negative findings if important. While reports of hospital or clinic-based treatments are not excluded, particularly if they have broad implications for cost-effective disease control or prevention, we give priority to papers addressing community-based activities. We encourage submissions on cardiovascular surveillance and health policies, professional education, ethical issues and technological innovations related to prevention. Global Heart is particularly interested in publishing data from updated national or regional demographic health surveys, World Health Organization or Global Burden of Disease data, large clinical disease databases or registries. Systematic reviews or meta-analyses on globally relevant topics are welcome. We will also consider clinical research that has special relevance to LMICs, e.g. using validated instruments to assess health-related quality-of-life in patients from LMICs, innovative diagnostic-therapeutic applications, real-world effectiveness clinical trials, research methods (innovative methodologic papers, with emphasis on low-cost research methods or novel application of methods in low resource settings), and papers pertaining to cardiovascular health promotion and policy (quantitative evaluation of health programs.