急性心力衰竭中的心室-动脉耦联：预后与治疗启示——基于多变量校正数据的系统评价与荟萃分析。
完整摘要 · 中文译文
在急性心力衰竭（AHF）中，无创心室-动脉耦联（VAC）替代指标，包括右心室-肺动脉（RV-PA）耦联和左心室-动脉（LV-Ao）耦联，已成为实用的床旁指标，但其预后意义在很大程度上仍未被系统性地了解。我们进行了一项系统综述和荟萃分析，以评估无创VAC评估在AHF住院患者中的预后意义。结局包括全因死亡率、HF住院、住院时间、治疗使用情况、全因死亡率和HF住院的复合终点以及院内不良心血管事件。采用随机效应模型汇总校正风险比（aHR）和比值比（aOR）。根据随访时长和左心室射血分数进行亚组分析。共分析36项研究，涵盖36,989例患者。28项研究评估了RV-PA耦联，主要为TAPSE/PASP比值，8项研究评估了LV-Ao耦联，主要使用无创Ea/Ees估计值。RV-PA脱耦联与全因死亡率增加独立相关（aHR 1.90；95% CI 1.42-2.56；I²=49%），在12个月时（aHR 2.03；95% CI 1.44-2.85）和长期随访中（aHR 1.67；95% CI 1.06-2.64）关联一致。与HF住院、住院时间和复合终点的关联方向一致，但无统计学显著性。LV-Ao脱耦联与院内不良心血管事件增加相关（aOR 1.70；95% CI 1.29-2.24） ）。敏感性分析证实了这些发现的稳健性。右心室-肺动脉（RV-PA）失偶联可预测死亡，而左心室-主动脉（LV-Ao）失偶联可识别院内不良心血管事件风险增加的患者，这支持在急性心力衰竭（AHF）中进行心室动脉偶联（VAC）风险分层，并支持未来评估以VAC为指导的治疗策略。
完整摘要 · 英文原文
In acute heart failure (AHF), non-invasive ventricular-arterial coupling (VAC) surrogates, including right ventricular-pulmonary arterial (RV-PA) and left ventricular-arterial (LV-Ao) coupling, have emerged as practical bedside indices, but their prognostic significance remains largely unknown systematically. We performed a systematic review and meta-analysis to evaluate the prognostic significance of non-invasive VAC assessment, in patients hospitalized with AHF. Outcomes included all-cause mortality, HF hospitalization, length of hospital stay, use of therapies, the composite of all-cause mortality and HF hospitalization, and in-hospital adverse cardiovascular events. Adjusted hazard ratios (aHRs) and odds ratios (aORs) were pooled using random-effects. Subgroup-analyses were performed according to follow-up duration and left ventricular ejection fraction. Thirty-six studies comprising 36,989 patients were analysed. Twenty-eight studies evaluated RV-PA coupling, predominantly the TAPSE/PASP ratio, and eight evaluated LV-Ao coupling, mainly using non-invasive Ea/Ees estimates. RV-PA uncoupling was independently associated with increased all-cause mortality (aHR 1.90; 95% CI 1.42-2.56; I²=49%), with consistent associations at 12 months (aHR 2.03; 95% CI 1.44-2.85) and long-term follow-up (aHR 1.67; 95% CI 1.06-2.64). Associations with HF hospitalization, hospital stay, and the composite endpoint were directionally consistent but not statistically significant. LV-Ao uncoupling was associated with increased in-hospital adverse cardiovascular events (aOR 1.70; 95% CI 1.29-2.24). Sensitivity analyses confirmed robustness of these findings. RV-PA uncoupling predicts mortality, whereas LV-Ao uncoupling identifies patients at increased risk of in-hospital adverse cardiovascular events, supporting VAC-risk-stratification in AHF and future evaluation of VAC-guided therapeutic strategies.