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JAMA Cardiol:评估左心室整体纵向应变对化疗诱导心脏毒性早期预测的预后价值-系统评价和Meta分析

2019-08-29 Shirl Q 医学论坛网心血管

超声心动图左心室整体纵向应变(GLS)检测早期亚临床心室功能障碍,可用于接受具有潜在心脏毒性的化疗患者。在该项荟萃分析之前,尚未存在针对GLS对癌症治疗相关心功能不全(CTRCD)的预后价值进行的荟萃分析。

超声心动图左心室整体纵向应变(GLS)检测早期亚临床心室功能障碍,可用于接受具有潜在心脏毒性的化疗患者。在该项荟萃分析之前,尚未存在针对GLS对癌症治疗相关心功能不全(CTRCD)的预后价值进行的荟萃分析。

目的:

探讨GLS对CTRCD预测的预后价值。

数据来源:

对MEDLINE,Embase,Scopus和Cochrane的图书馆数据库进行系统搜索,从数据库开始到2018年6月1日。

研究选择:

队列研究在随后的CTRCD化疗之前或期间评估GLS的预后或辨别性表现。

数据提取和合成:

随机效应荟萃分析和分层汇总接收器操作特征曲线(HSROCs)用于总结不同GLS指数的预后和鉴别性能。使用Egger测试评估发表偏倚,并进行元回归以评估异质性的来源。

主要结果和措施:

主要结果是CTRCD,定义为伴有或不伴有新发心力衰竭症状的左心室射血分数的临床显着变化。

结果:

分析包括21项研究,包括1782名患有癌症的患者,包括乳腺癌,恶性血液病或肉瘤,用含有或不含曲妥珠单抗的蒽环霉素治疗。 CTRCD的发生率在平均随访4.2至23.0个月时为9.3%至43.8%(合并发生率,21.0%)。对于积极治疗绝对GLS(9项研究),高风险截断值范围为-21.0%至-13.8%,较差的GLS与较高的CTRCD风险相关(优势比,12.27; 95%CI,7.73-19.47;HSROC下的面积,0.86; 95%CI,0.83-0.89)。相对于基线值的相对变化(9项研究),截止值范围为2.3%至15.9%,更大的降低与CTRCD风险的16倍相关(优势比,15.82; 95%CI,5.84-42.85; HSROC下的面积,0.86; 95%CI,0.83-0.89)。两项指数都显示出重大的发表偏差。Meta回归确定了样本量和CTRCD定义的差异,但未将GLS临界值作为研究异质性的重要来源。

结论和相关性:

在这项荟萃分析中,开始使用含或不含曲妥珠单抗的蒽环类药物进行具潜在心脏毒性的化疗后GLS的测量对随后的CTRCD具有良好的预后表现。然而,原始研究中的偏倚风险,发表偏倚以及GLS增量值的有限数据及其最佳截止值突出了更广泛的前瞻性多中心研究的必要性。

原始出处:Evangelos K. Oikonomou, MD1; Damianos G. Kokkinidis, MD, MSc2; Polydoros N. Kampaktsis, MD3; et al. Assessment of Prognostic Value of Left Ventricular Global Longitudinal Strain for Early Prediction of Chemotherapy-Induced Cardiotoxicity: A Systematic Review and Meta-analysis. JAMA Cardiol. August 21, 2019.

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    2019-10-27 guojianrong
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    2020-07-17 一闲
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  6. [GetPortalCommentsPageByObjectIdResponse(id=1888055, encodeId=c77018880552d, content=<a href='/topic/show?id=d56611584ec' target=_blank style='color:#2F92EE;'>#Meta#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11584, encryptionId=d56611584ec, topicName=Meta)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8f4110, createdName=guojianrong, createdTime=Sun Oct 27 07:29:00 CST 2019, time=2019-10-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1896539, encodeId=e2881896539d8, content=<a href='/topic/show?id=4a391158248' target=_blank style='color:#2F92EE;'>#MET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11582, encryptionId=4a391158248, topicName=MET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18fc139, createdName=一闲, createdTime=Fri Jul 17 22:29:00 CST 2020, time=2020-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1782062, encodeId=893e1e82062aa, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Sat Sep 28 20:29:00 CST 2019, time=2019-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1385228, encodeId=8f0213852280a, content=<a href='/topic/show?id=dc121001e22d' target=_blank style='color:#2F92EE;'>#预后价值#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100172, encryptionId=dc121001e22d, topicName=预后价值)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=70fe497, createdName=paperyu, createdTime=Fri Aug 30 17:29:00 CST 2019, time=2019-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1413263, encodeId=87861413263f5, content=<a href='/topic/show?id=1d7e48033f5' target=_blank style='color:#2F92EE;'>#左心室#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=48033, encryptionId=1d7e48033f5, topicName=左心室)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=15012955474, createdName=wushaoling, createdTime=Fri Aug 30 17:29:00 CST 2019, time=2019-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1444570, encodeId=87f014445e033, content=<a href='/topic/show?id=3d9291459d1' target=_blank style='color:#2F92EE;'>#评价#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91459, encryptionId=3d9291459d1, topicName=评价)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1fee5134542, createdName=huagfeg, createdTime=Fri Aug 30 17:29:00 CST 2019, time=2019-08-30, status=1, ipAttribution=)]
    2019-08-30 huagfeg
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