Andrea Sonaglioni, Valeria Fagiani, Gian L Nicolosi, Michele Lombardo
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The present systematic review and meta-analysis has been primarily designed to summarize the main findings of these studies and to examine the overall influence of PE on both left ventricular (LV)- and right ventricular (RV)-global longitudinal strain (GLS).</p><p><strong>Evidence acquisition: </strong>All imaging studies assessing conventional indices of biventricular size and function and myocardial strain parameters in PE individuals vs.. healthy controls, selected from PubMed and EMBASE databases, were included. The risk of bias was evaluated by using the National Institutes of Health (NIH) Quality Assessment of Case-Control Studies. Continuous data (LV-GLS and RV-GLS) were pooled as a standardized mean difference (SMD) comparing PE group with healthy controls. The overall SMDs of LV-GLS and RV-GLS were calculated using the random-effect model.</p><p><strong>Evidence synthesis: </strong>The full-text of 7 studies with a total of 374 PE individuals and 141 healthy controls were analyzed. Both average LV-GLS (-17.1±3.5% vs. -18.9±3.0%, P<0.001) and RV-GLS (-17.9±5.2% vs. -20.9±3.7%, P<0.001) were significantly lower in PE patients than controls. Subtotal SMD was small and not statistically significant for CMR studies assessing LV-GLS (-0.23, 95%CI -0.92,0.47, P=0.52) and RV-GLS (-0.33, 95%CI -0.94,0.28, P=0.28), whereas subtotal SMD was large and statistically significant for echocardiographic studies measuring LV-GLS (-1.46, 95%CI -2.55,-0.38, P=0.008) and RV-GLS (-1.71, 95%CI -2.68,-0.74, P=0.001). The overall effect of PE was statistically significant on RV-GLS (SMD -0.72, 95%CI -1.24,-0.21, P=0.006), but not on LV-GLS (SMD -0.58, 95%CI -1.17,-0.00, P=0.05). Substantial heterogeneity was found for the studies assessing LV-GLS (I<sup>2</sup>=88.2%) and RV-GLS (I<sup>2</sup>=86.9%). Egger's test gave a P-value of 0.64 for LV-GLS and 0.47 for RV-GLS assessment, indicating no publication bias. On meta-regression analysis, none of the moderators was significantly associated with effect modification for both LV-GLS and RV-GLS (all P<0.05).</p><p><strong>Conclusions: </strong>The influence of PE on RV mechanics is greater than on LV mechanics. STE and FT-CMR may detect subtle impairment in biventricular mechanics in PE individuals. 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The present systematic review and meta-analysis has been primarily designed to summarize the main findings of these studies and to examine the overall influence of PE on both left ventricular (LV)- and right ventricular (RV)-global longitudinal strain (GLS).</p><p><strong>Evidence acquisition: </strong>All imaging studies assessing conventional indices of biventricular size and function and myocardial strain parameters in PE individuals vs.. healthy controls, selected from PubMed and EMBASE databases, were included. The risk of bias was evaluated by using the National Institutes of Health (NIH) Quality Assessment of Case-Control Studies. Continuous data (LV-GLS and RV-GLS) were pooled as a standardized mean difference (SMD) comparing PE group with healthy controls. 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引用次数: 0
摘要
导言：在过去的十年中，有少量研究使用特征追踪（FT）心血管磁共振成像（CMR）和斑点追踪超声心动图（STE）来研究开胸症（PE）对双心室力学的影响。本系统性综述和荟萃分析的主要目的是总结这些研究的主要发现，并研究 PE 对左心室（LV）和右心室（RV）整体纵向应变（GLS）的总体影响：从 PubMed 和 EMBASE 数据库中筛选出所有评估 PE 患者与健康对照者双心室大小和功能的常规指数以及心肌应变参数的成像研究。采用美国国立卫生研究院（NIH）病例对照研究质量评估方法对偏倚风险进行评估。连续数据（LV-GLS 和 RV-GLS）以 PE 组与健康对照组比较的标准化平均差 (SMD) 的形式进行汇总。使用随机效应模型计算 LV-GLS 和 RV-GLS 的总体 SMD：对 7 项研究的全文进行了分析，共涉及 374 名 PE 患者和 141 名健康对照者。平均LV-GLS（-17.1±3.5% vs. -18.9±3.0%，P2=88.2%）和RV-GLS（I2=86.9%）。Egger检验显示，LV-GLS评估的P值为0.64，RV-GLS评估的P值为0.47，表明无发表偏倚。在元回归分析中，没有一个调节因子与 LV-GLS 和 RV-GLS 的效应修饰显著相关（所有 PConclusions：PE对RV力学的影响大于对LV力学的影响。STE 和 FT-CMR 可检测出 PE 患者双心室力学的细微损伤。STE 揭示的心肌应变指数衰减可能因方法问题而增强。
The influence of pectus excavatum on biventricular mechanics: a systematic review and meta-analysis.
Introduction: During the last decade, a small number of studies have used feature tracking (FT) cardiovascular magnetic resonance imaging (CMR) and speckle tracking echocardiography (STE) to investigate the effect of pectus excavatum (PE) on biventricular mechanics. The present systematic review and meta-analysis has been primarily designed to summarize the main findings of these studies and to examine the overall influence of PE on both left ventricular (LV)- and right ventricular (RV)-global longitudinal strain (GLS).
Evidence acquisition: All imaging studies assessing conventional indices of biventricular size and function and myocardial strain parameters in PE individuals vs.. healthy controls, selected from PubMed and EMBASE databases, were included. The risk of bias was evaluated by using the National Institutes of Health (NIH) Quality Assessment of Case-Control Studies. Continuous data (LV-GLS and RV-GLS) were pooled as a standardized mean difference (SMD) comparing PE group with healthy controls. The overall SMDs of LV-GLS and RV-GLS were calculated using the random-effect model.
Evidence synthesis: The full-text of 7 studies with a total of 374 PE individuals and 141 healthy controls were analyzed. Both average LV-GLS (-17.1±3.5% vs. -18.9±3.0%, P<0.001) and RV-GLS (-17.9±5.2% vs. -20.9±3.7%, P<0.001) were significantly lower in PE patients than controls. Subtotal SMD was small and not statistically significant for CMR studies assessing LV-GLS (-0.23, 95%CI -0.92,0.47, P=0.52) and RV-GLS (-0.33, 95%CI -0.94,0.28, P=0.28), whereas subtotal SMD was large and statistically significant for echocardiographic studies measuring LV-GLS (-1.46, 95%CI -2.55,-0.38, P=0.008) and RV-GLS (-1.71, 95%CI -2.68,-0.74, P=0.001). The overall effect of PE was statistically significant on RV-GLS (SMD -0.72, 95%CI -1.24,-0.21, P=0.006), but not on LV-GLS (SMD -0.58, 95%CI -1.17,-0.00, P=0.05). Substantial heterogeneity was found for the studies assessing LV-GLS (I2=88.2%) and RV-GLS (I2=86.9%). Egger's test gave a P-value of 0.64 for LV-GLS and 0.47 for RV-GLS assessment, indicating no publication bias. On meta-regression analysis, none of the moderators was significantly associated with effect modification for both LV-GLS and RV-GLS (all P<0.05).
Conclusions: The influence of PE on RV mechanics is greater than on LV mechanics. STE and FT-CMR may detect subtle impairment in biventricular mechanics in PE individuals. The attenuation of myocardial strain indices revealed by STE may be enhanced by methodological issues.
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