射频消融治疗梗阻性肥厚型心肌病有效性及安全性的系统评价和Meta分析

Effectiveness and safety of radiofrequency ablation in the treatment of hypertrophic obstructive cardiomyopathy:a systematic review and meta-analysis

目的应用Meta分析评估射频消融治疗梗阻性肥厚型心肌病的有效性及安全性。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、中国期刊全文数据库(CNKI)、万方数据知识服务平台、维普中文科技期刊全文数据库,检索时限均为从建库至2022年5月16日,按照纳入与排除标准独立筛选文献、提取资料,并评价纳入研究的质量,采用Stata 16.0软件进行Meta分析。结果最终纳入13篇研究,共计387例患者。Meta分析结果显示,射频消融治疗后,患者术后静息状态左心室流出道压力阶差(LVOTG;WMD=55.85,95%CI49.36~62.34,P<0.001)和术后激发状态LVOTG(WMD=95.58,95%CI75.77~115.38,P<0.001)均有明显改善,差异均有统计学意义。术后室间隔厚度(WMD=4.06,95%CI1.66~6.46,P<0.001)和纽约心脏病协会心功能分级(WMD=1.26,95%CI0.94~1.58,P<0.001)较术前均有所改善,差异均有统计学意义。结论应用射频消融术来治疗梗阻性肥厚型心肌病可以缓解患者的临床症状并改善预后。射频消融治疗有望成为一种新型的、有前途的替代治疗方法。

Objective The purpose of this systematic review is to investigate effectiveness and safety of radiofrequency ablation in the treatment of hypertrophic obstructive cardiomyopathy.Methods PubMed,Embase,the Cochrane Library,Web of Science,CNKI,Wanfang Data and VIP were searched from inception until May 16,2022.According to the criteria of inclusion and exclusion,two reviewers independently screened the literature,extracted the data and evaluated the quality of the included studies.Then,Stata 16.0 software was used for meta-analysis.Results Thirteen studies were included with a total of 387 patients.Meta-analysis results showed that the LVOTG at rest(WMD=55.85,95%CI 49.36—62.34,P<0.001)a n d t h e p r o v o k ed LVOTG(W M D=95.58,95%CI 75.77—115.38,P<0.001)were decreased significantly after radiofrequency ablation.The difference was statistically significant.Ventricular septal thickness(WMD=4.06,95%CI 1.66—6.46,P<0.001)and NYHA(WMD=1.26,95%CI 0.94—1.58,P<0.001)were improved after radiofrequency ablation.The difference was statistically significant.Conclusions The use of radiofrequency ablation for the treatment of obstructive hypertrophic cardiomyopathy may reduce clinical symptoms and improve prognosis,and is expected to be a new and promising alternative treatment.