David Koeckerling, Rohin K Reddy, Christian Eichhorn, Volker Braun, Yousif Ahmad, James P Howard, Fabian Aus dem Siepen, Benjamin Meder, Norbert Frey, Derliz Mereles
{"title":"轻链和转甲状腺蛋白淀粉样变性的超声心动图危险分层：荟萃分析。","authors":"David Koeckerling, Rohin K Reddy, Christian Eichhorn, Volker Braun, Yousif Ahmad, James P Howard, Fabian Aus dem Siepen, Benjamin Meder, Norbert Frey, Derliz Mereles","doi":"10.1093/ehjopen/oeaf078","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>The role of echocardiography in amyloidosis prognostication remains undefined in international guidelines. This meta-analysis aims to evaluate associations between echocardiography-derived measurements and clinical outcomes in light chain (AL) and transthyretin (ATTR) amyloidosis.</p><p><strong>Methods and results: </strong>MEDLINE, Embase, Cochrane Library, and Google Scholar were systematically searched through July 2024 for studies reporting associations between echocardiographic variables [left ventricular global longitudinal strain (LV-GLS), LV ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), interventricular septum diameter (IVSd), LV mass index (LVMi) and <i>E</i>/<i>e</i>' ratios] and adverse events in AL or ATTR amyloidosis. Prespecified demographic items and clinical outcomes were extracted by two blinded, independent reviewers. The prespecified primary outcome was all-cause mortality. Random-effect models were applied to pool hazard ratios (HR). 94 studies comprising 16158 patients (<i>n</i> = 4788 AL, <i>n</i> = 8241 ATTR, <i>n</i> = 3129 mixed aetiologies) were included. Median follow-up was 22.3 (IQR, 16.9-31.4) months. Higher all-cause mortality risk (HR, 1.10: 95%CI, 1.08-1.12; <i>P</i> < 0.001) was observed per 1% LV-GLS decrement, consistent across AL and ATTR subgroups. Lower all-cause mortality risk was seen with increasing LVEF (per 1%) and TAPSE (per 1 mm) in the overall population (HR<sub>LVEF</sub>, 0.98; 95%CI, 0.98-0.98; <i>P</i> < 0.001; and HR<sub>TAPSE</sub>, 0.94; 95%CI, 0.93-0.95; <i>P</i> < 0.001) and in AL and ATTR subgroups. Higher <i>E</i>/<i>e</i>' ratios (per 1 unit) were associated with all-cause mortality (HR, 1.02; 95%CI, 1.02-1.03; <i>P</i> < 0.001), consistent across AL and ATTR subtypes. No reliable associations between structural parameters (IVSd, LVMi) and clinical outcomes were found.</p><p><strong>Conclusion: </strong>Echocardiographic measures of biventricular deformation, systolic and diastolic function, were consistently associated with mortality in amyloidosis, while structural parameters were not. Echocardiography may have an important role in the initial risk stratification of cardiac amyloidosis.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 4","pages":"oeaf078"},"PeriodicalIF":0.0000,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12370300/pdf/","citationCount":"0","resultStr":"{\"title\":\"Echocardiographic risk stratification in light chain and transthyretin amyloidosis: a meta-analysis.\",\"authors\":\"David Koeckerling, Rohin K Reddy, Christian Eichhorn, Volker Braun, Yousif Ahmad, James P Howard, Fabian Aus dem Siepen, Benjamin Meder, Norbert Frey, Derliz Mereles\",\"doi\":\"10.1093/ehjopen/oeaf078\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>The role of echocardiography in amyloidosis prognostication remains undefined in international guidelines. This meta-analysis aims to evaluate associations between echocardiography-derived measurements and clinical outcomes in light chain (AL) and transthyretin (ATTR) amyloidosis.</p><p><strong>Methods and results: </strong>MEDLINE, Embase, Cochrane Library, and Google Scholar were systematically searched through July 2024 for studies reporting associations between echocardiographic variables [left ventricular global longitudinal strain (LV-GLS), LV ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), interventricular septum diameter (IVSd), LV mass index (LVMi) and <i>E</i>/<i>e</i>' ratios] and adverse events in AL or ATTR amyloidosis. Prespecified demographic items and clinical outcomes were extracted by two blinded, independent reviewers. The prespecified primary outcome was all-cause mortality. Random-effect models were applied to pool hazard ratios (HR). 94 studies comprising 16158 patients (<i>n</i> = 4788 AL, <i>n</i> = 8241 ATTR, <i>n</i> = 3129 mixed aetiologies) were included. Median follow-up was 22.3 (IQR, 16.9-31.4) months. Higher all-cause mortality risk (HR, 1.10: 95%CI, 1.08-1.12; <i>P</i> < 0.001) was observed per 1% LV-GLS decrement, consistent across AL and ATTR subgroups. Lower all-cause mortality risk was seen with increasing LVEF (per 1%) and TAPSE (per 1 mm) in the overall population (HR<sub>LVEF</sub>, 0.98; 95%CI, 0.98-0.98; <i>P</i> < 0.001; and HR<sub>TAPSE</sub>, 0.94; 95%CI, 0.93-0.95; <i>P</i> < 0.001) and in AL and ATTR subgroups. Higher <i>E</i>/<i>e</i>' ratios (per 1 unit) were associated with all-cause mortality (HR, 1.02; 95%CI, 1.02-1.03; <i>P</i> < 0.001), consistent across AL and ATTR subtypes. No reliable associations between structural parameters (IVSd, LVMi) and clinical outcomes were found.</p><p><strong>Conclusion: </strong>Echocardiographic measures of biventricular deformation, systolic and diastolic function, were consistently associated with mortality in amyloidosis, while structural parameters were not. Echocardiography may have an important role in the initial risk stratification of cardiac amyloidosis.</p>\",\"PeriodicalId\":93995,\"journal\":{\"name\":\"European heart journal open\",\"volume\":\"5 4\",\"pages\":\"oeaf078\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-08-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12370300/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European heart journal open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1093/ehjopen/oeaf078\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/7/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European heart journal open","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/ehjopen/oeaf078","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/7/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的：超声心动图在淀粉样变预后中的作用在国际指南中仍未明确。本荟萃分析旨在评估轻链（AL）和转甲状腺素（ATTR）淀粉样变的超声心动图衍生测量与临床结果之间的关系。方法和结果：MEDLINE、Embase、Cochrane Library和谷歌Scholar系统检索了截至2024年7月的超声心动图变量[左室总纵应变（LV- gls）、左室射血分数（LVEF）、三尖瓣环平面收缩偏移（TAPSE）、室间隔直径（IVSd）、左室质量指数（LVMi）和E/ E比值]与AL或ATTR淀粉样变性不良事件之间的关联研究。预先指定的人口学项目和临床结果由两位盲法独立评论者提取。预先设定的主要结局是全因死亡率。随机效应模型应用于池风险比（HR）。纳入94项研究，包括16158例患者（n = 4788例AL， n = 8241例atr， n = 3129例混合病因）。中位随访时间为22.3个月（IQR, 16.9-31.4）。LV-GLS每降低1%，全因死亡风险更高（HR, 1.10: 95%CI, 1.08-1.12; P < 0.001），这在AL和ATTR亚组中是一致的。在总体人群（HRLVEF, 0.98; 95%CI, 0.98-0.98; P < 0.001； HRTAPSE, 0.94; 95%CI, 0.93-0.95; P < 0.001）和AL和ATTR亚组中，随着LVEF（每1%）和TAPSE（每1 mm）的增加，全因死亡风险降低。较高的E/ E '比（每1单位）与全因死亡率相关（HR, 1.02; 95%CI, 1.02-1.03; P < 0.001），在AL和ATTR亚型中是一致的。结构参数（IVSd, LVMi）与临床结果之间没有可靠的关联。结论：超声心动图测量的双心室变形、收缩和舒张功能与淀粉样变性患者的死亡率一致相关，而结构参数与之无关。超声心动图可能在心脏淀粉样变的初始危险分层中起重要作用。
Echocardiographic risk stratification in light chain and transthyretin amyloidosis: a meta-analysis.
Aims: The role of echocardiography in amyloidosis prognostication remains undefined in international guidelines. This meta-analysis aims to evaluate associations between echocardiography-derived measurements and clinical outcomes in light chain (AL) and transthyretin (ATTR) amyloidosis.
Methods and results: MEDLINE, Embase, Cochrane Library, and Google Scholar were systematically searched through July 2024 for studies reporting associations between echocardiographic variables [left ventricular global longitudinal strain (LV-GLS), LV ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), interventricular septum diameter (IVSd), LV mass index (LVMi) and E/e' ratios] and adverse events in AL or ATTR amyloidosis. Prespecified demographic items and clinical outcomes were extracted by two blinded, independent reviewers. The prespecified primary outcome was all-cause mortality. Random-effect models were applied to pool hazard ratios (HR). 94 studies comprising 16158 patients (n = 4788 AL, n = 8241 ATTR, n = 3129 mixed aetiologies) were included. Median follow-up was 22.3 (IQR, 16.9-31.4) months. Higher all-cause mortality risk (HR, 1.10: 95%CI, 1.08-1.12; P < 0.001) was observed per 1% LV-GLS decrement, consistent across AL and ATTR subgroups. Lower all-cause mortality risk was seen with increasing LVEF (per 1%) and TAPSE (per 1 mm) in the overall population (HRLVEF, 0.98; 95%CI, 0.98-0.98; P < 0.001; and HRTAPSE, 0.94; 95%CI, 0.93-0.95; P < 0.001) and in AL and ATTR subgroups. Higher E/e' ratios (per 1 unit) were associated with all-cause mortality (HR, 1.02; 95%CI, 1.02-1.03; P < 0.001), consistent across AL and ATTR subtypes. No reliable associations between structural parameters (IVSd, LVMi) and clinical outcomes were found.
Conclusion: Echocardiographic measures of biventricular deformation, systolic and diastolic function, were consistently associated with mortality in amyloidosis, while structural parameters were not. Echocardiography may have an important role in the initial risk stratification of cardiac amyloidosis.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
