Andrea Sonaglioni, Priscilla Torretta, Gian L Nicolosi, Michele Lombardo
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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.</p><p><strong>Results: </strong>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<sup>2</sup>=92.5%), LV-BLS (I<sup>2</sup>=91.4%), LV-MLS (I<sup>2</sup>=94.3%) and LV-ALS (I<sup>2</sup>=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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":18668,"journal":{"name":"Minerva cardiology and angiology","volume":" ","pages":""},"PeriodicalIF":1.3000,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Left ventricular mechanics assessment in amyloidosis patients: a systematic review and meta-analysis.\",\"authors\":\"Andrea Sonaglioni, Priscilla Torretta, Gian L Nicolosi, Michele Lombardo\",\"doi\":\"10.23736/S2724-5683.24.06683-3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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. 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引用次数: 0
摘要
背景：在过去的十年中，少量的研究使用斑点跟踪超声心动图（STE）或心脏磁共振（CMR）来测量淀粉样变性患者的左心室（LV）力学。本系统综述和荟萃分析旨在评估淀粉样变性对左室整体纵向应变（GLS）和区域纵向应变在基底（BLS）、中（MLS）和根尖（ALS）水平的总体影响。方法：从PubMed和EMBASE数据库中选择淀粉样变患者与健康对照的所有影像学研究，评估LV-GLS、LV-BLS、LV-MLS和LV-ALS。偏倚风险通过美国国立卫生研究院（NIH）病例对照研究质量评估进行评估。将连续数据（LV-GLS、LV-BLS、LV-MLS和LV-ALS）汇总为淀粉样变组与健康对照组的标准化平均差异（SMDs）。采用随机效应模型计算LV-GLS、LV-BLS、LV-MLS和LV-ALS的总体smd。结果：对553例淀粉样变性患者和575例健康对照者的13项研究全文进行分析。STE（53.8%）和CMR（46.2%）分别进行分析。STE（13.8±3.9 vs. 19.8±2.7%）和CMR（12.3±4 vs. 17.9±3.5%）研究中淀粉样变性患者的平均LV-GLS幅度均明显低于对照组。在淀粉样变患者中检测到的节段应变损伤普遍存在于基础和中期水平，相对“根尖保留”。获得了LV-GLS （SMD -1.80, 95% CI: -2.35, -1.24, P 2=92.5%）、LV-BLS （I2=91.4%）、LV-MLS （I2=94.3%）和LV-ALS （I2=94.6%）的SMD。LV-GLS、LV-BLS、LV-MLS和LV-ALS评估的Egger检验P值分别为0.10、0.20、0.09和0.55，无发表偏倚。在meta回归分析中，没有一个调节因子与LV-GLS、LV-BLS、LV-MLS和LV-ALS的疗效改变显著相关（均为p）。结论：淀粉样变性对LV-GLS有很大的负面影响，主要与基底和中期节段纵向应变的恶化有关，相对根尖保留。
Left ventricular mechanics assessment in amyloidosis patients: a systematic review and meta-analysis.
Background: 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.
Methods: 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.
Results: 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 (I2=92.5%), LV-BLS (I2=91.4%), LV-MLS (I2=94.3%) and LV-ALS (I2=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).
Conclusions: 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.
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