慢性阻塞性肺病 (COPD) 对没有严重气流阻塞的患者双管管机械学的影响
Andrea Sonaglioni1, Massimo Baravelli1, Antonella Caminati2
1Division of Cardiology, IRCCS MultiMedica, 20123 Milan, Italy.
慢性阻塞性肺病 (COPD) 与双心脏力学减弱有关,即使在早期阶段也是如此. 斑点跟踪心声学 (STE) 可以检测COPD患者的亚临床心脏功能障碍,有助于早期评估心血管并发症的风险.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 医疗成像医学成像
背景情况:
- 在慢性阻塞性肺病 (COPD) 患者的双心室机械学上存在有限的回声心脏学研究,这些患者没有晚期肺病.
- 斑点跟踪回声心电图 (STE) 提供了超越传统方法的心脏功能的高级评估.
- 了解COPD中的亚临床心脏功能障碍对于风险分层至关重要.
研究的目的:
- 使用STE系统地审查和量化COPD对双心脏力学的影响.
- 在没有严重气流阻塞的COPD患者中评估左心室 (LV) 和右心室 (RV) 全球纵向应变 (GLS).
- 在COPD患者中识别心肌功能障碍的早期迹象.
主要方法:
- 一项对10项涉及682名COPD患者和316名健康对照患者的研究的元分析.
- 纳入标准:用于LV-GLS和RV-GLS分析的使用STE的跨胸腔心声学 (TTE) 的研究.
- 使用标准化平均差异 (SMD) 汇集数据,将COPD患者与LV-GLS,RV-GLS,LVEF和TAPSE的对照进行比较.
主要成果:
- 慢性肺炎对LV-GLS (SMD-1.296) 和RV-GLS (SMD-1.474) 有显著影响,表明有很大的有害影响.
- 观察到对三环状平面缩外流 (TAPSE) (SMD -0.783) 的中度至大效应,以及对左心室喷射率 (LVEF) 的小效应 (SMD -0.366).
- 在LV-GLS,RV-GLS和LVEF研究中发现了很高的异质性,但没有发表偏差. 敏感性分析证实了结果的可靠性.
结论:
- 慢性肺炎独立地与轻微的双心膜机械损伤有关,即使在传统的TTE上保留了LVEF和TAPSE.
- 在中度气流限制的COPD患者中,STE可以检测亚临床心肌功能障碍.
- 通过STE早期识别心脏功能障碍可能有助于预测心力衰竭风险和COPD心血管并发症.
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