左心房应变参数对房颤复发风险的预测准确性：系统综述和荟萃分析

摘要(中文译文)

近年来，关于左心房应变参数用于预测心房颤动（AF）复发的临床证据不断增加。本研究旨在评估这些参数对AF复发的预测能力。我们系统检索了Cochrane Library、Embase、PubMed和Web of Science自建库至2025年10月20日的文献，纳入探讨AF复发与各种左心房应变参数之间关联的队列研究，这些参数包括心房纵向峰值应变（PALS，P波触发）、左心房储备应变（LASr，R波触发）、左心房管道应变（LAScd）和左心房收缩应变（LASct）。采用随机效应模型合并风险比（RR）和预测性能指标。进行了敏感性分析、发表偏倚评估和亚组分析。共纳入25项研究，涵盖3，649例患者。荟萃分析表明，治疗前测得的PALS和LASr是AF复发的有效预测因子。作为分类变量分析时，较高的PALS（RR = 0.08，95% CI：0.04-0.16）和较高的LASr（RR = 0.91，95% CI：0.86-0.96）均与AF复发风险显著降低相关。作为连续变量处理时，PALS每增加1个单位（RR = 0.88，95% CI：0.85-0.91）或LASr每增加1个单位（RR = 0.93，95% CI：0.88-0.99）均与AF复发风险显著降低相关。PALS和LASr的合并AUC值分别为0.75和0.78。其他参数的预测能力有限或不明确：治疗前测得的LASct和LAScd，以及治疗后测得的LASr（无论是作为分类变量还是连续变量），均未能显示出显著的预测能力（均 > 0.05）。仅在治疗后测得的LASct作为连续变量时，LASct每升高1个单位与AF复发风险降低相关（RR = 0.75，95% CI：0.63-0.91）。本研究表明，较低的PALS和LASr值与较高的AF复发风险相关。此外，PALS和LASr对AF复发显示出相对较好的预测性能。https://www.crd.york.ac.uk/PROSPERO/view/CRD420251182805，注册号：CRD420251182805。

Abstract

Clinical evidence, in recent years, has increased regarding the application of left atrial strain parameters for the prediction of atrial fibrillation (AF) recurrence. This study endeavors to assess the predictive power of these parameters for AF recurrence. We systematically searched Cochrane Library, Embase, PubMed, and Web of Science from inception to October 20, 2025, for cohort studies investigating the association between AF recurrence and various left atrial strain parameters, including peak atrial longitudinal strain (PALS, P-wave-triggered), left atrial reservoir strain (LASr, R-wave-triggered), left atrial conduit strain (LAScd), and left atrial contraction strain (LASct). A random-effects model was used to pool risk ratios (RRs) and predictive performance metrics. Sensitivity analysis, publication bias assessment, and subgroup analysis were performed. Totally 25 studies covering 3,649 patients were included. The meta-analysis indicated that PALS and LASr measured before treatment were effective predictors for AF recurrence. Analyzed as categorical variables, both a higher PALS (RR = 0.08, 95% CI: 0.04-0.16) and a higher LASr (RR = 0.91, 95% CI: 0.86-0.96) were linked to a significantly lower risk of AF relapse. Treated as continuous variables, a 1-unit increase in PALS (RR = 0.88, 95% CI: 0.85-0.91) or LASr (RR = 0.93, 95% CI: 0.88-0.99) was associated with a pronounced lower risk of AF recurrence. The pooled AUC values for PALS and LASr were 0.75 and 0.78, respectively. The predictive power of other parameters was limited or unclear: LASct and LAScd measured before treatment, as well as LASr measured after treatment (either as a categorical variable or a continuous variable), failed to show significant predictive power (all > 0.05). Only for LASct measured after treatment as a continuous variable, each unit elevation in LASct was linked to a reduced risk of AF relapse (RR = 0.75, 95% CI: 0.63-0.91). This study suggests that lower PALS and LASr values are associated with a higher risk of AF recurrence. In addition, PALS and LASr shows relatively favorable predictive performance for AF recurrence. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251182805, identifier: CRD420251182805.

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