Meta-Analysis Of Prognostic Factors Associated With Left Ventricular Non-Compaction And Clinical Features Of 22 Cases Of Adult Left Ventricular Non-Compaction

Part 1 Meta-analysis of factors affecting the prognosis of myocardial incomplete compaction Objective:Left ventricular non-compaction(LVNC)is a rare disease with a poor prognosis.Although many studies have reported the influence of various factors on the prognosis of LVNC,the results are still controversial.Therefore,this study intends to further evaluate the effects of various influencing factors on the prognosis of myocardial incomplete compaction through meta-analysis.Methods:By searching Pubmed,Embase,Web of science,Cochrane Library,CNKI,Wanfang and other databases,all the literatures related to LVNC prognostic factors published before January 2021 were obtained.Extract the basic characteristics of the literature and prognostic related factors,such as the general characteristics of the patient,other diseases,biochemical indicators,ultrasound and other imaging examination related indicators.The quality of the included studies was evaluated by two authors based on the Newcastle-Ottawa Scale(NOS).Use STATA 15.0 software to perform statistical analysis on each prognostic factor,use hazard ratio(HR),95% confidence interval(confidence interval,CI)to evaluate the relationship between each factor and the prognosis of LVNC,and sensitivity analysis to evaluate the summary results For robustness,Egger’s test was used to evaluate the publication offset.Results:A total of 20 cohort studies were included in this study,with a total of 1910 patients.The results of the Meta analysis are as follows:1.The patient’s New York heart function classification is grade three or four(NYHA Ⅲ/Ⅳ),N-terminal brain natriuretic peptide(NT-proBNP),left ventricular ejection fraction,left ventricular end diastolic diameter(left ventricular End-diastolic diameter(LVEDD)and body mass index(BMI)have statistically significant differences in the prognosis of LVNC,among which NYHA Ⅲ/Ⅳ(HR=3.93,95% Cl:1.66-9.29),(NT-proBNP)increased(HR=1.98,95% CI: 1.10-3.58),left ventricular ejection fraction decreased(HR=1.04,95% CI: 1.03-1.06),LVEDD increased(HR=1.03,95% CI: 1.01-1.06)was an independent poor prognostic factor,and BMI(HR=0.80,95% CI: 0.64-0.98)was an independent protective factor.With atrial fibrillation(HR=1.71,95%CI: 1.22-2.41)and left atrial diameter(LAD)(HR=1.06,95%CI: 1.02-1.11),there is a statistically significant difference in the prognosis of LVNC.2.Patient’s age(HR=1.03,95%CI: 0.99-1.07),gender(HR=1.20,95%CI: 0.87-1.67),combined with hypertension(HR=1.05,95%CI: 0.46-2.39),Combined with coronary heart disease(HR=1.01,95%CI:0.64-1.62),combined with diabetes(HR=1.59,95%CI: 0.69-3.04),Creatinine level(HR=1.09,95% CI:0.95-1.25),late gadolinium-enhanced imaging(late gadolinium-enhanced,LGE)(HR=3.1,95% CI:0.85-11.31)all have no difference in the prognosis of LVNC Statistical significance.Conclusion:In LVNC patients,NYHA Ⅲ/Ⅳ,elevated NT-proBNP levels,decreased LVEF,and increased LVEDD may lead to poor prognosis,and increased BMI may improve the prognosis of LVNC.Part 2 Clinical analysis of 22 cases of adult myocardial insufficiencyObjective:Collect clinical data,ultrasound imaging characteristics and prognosis of some patients with adult myocardial insufficiency Situation and improve clinicians’ awareness of the disease.Methods: Collected 22 cases of adult myocardial insufficiency patients diagnosed in the First Affiliated Hospital of Shihezi University School of Medicine from 2014 to 2020.Statistics of patients’ clinical medical records include: age,gender,symptoms at onset,NYHA cardiac function classification,electrocardiogram,N-terminal brain natriuretic precursor peptide,creatinine level,echocardiographic related indicators such as left ventricular ejection fraction,left ventricular end-diastolic diameter,The diameter of the left atrium,the thickness of the dense layer,the ratio of the thickness of the non-dense layer to the thickness of the dense layer,and the number of ventricular segments involved in the non-dense myocardium.According to the left ventricular segment division method of the New York Heart Association(AHA),the patients were divided into 3 groups according to the number of affected segments,and the differences between the groups and the correlation analysis were analyzed by statistics.Results:There were 22 patients in this study,including 17 males(77.3%)and 5 females(22.7%).The average age was 50.05±20.61 years(19-86 years).Seven patients with repeated hospitalizations were admitted to the hospital with chest tightness and chest pain as the main complaints.Among them,3 patients had increased left atrium diameter at the last and first visits,4 patients had increased left ventricular end-diastolic diameter at the last and first visits,and 6 patients were admitted to the hospital.NYHA heart function classification Ⅲ/Ⅳ.The results of 18 patients included in the statistical analysis are as follows:1.There is no correlation between the left ventricular ejection fraction and the thickness of the dense layer,and the ratio of the thickness of the non-dense layer to the thickness of the dense layer,P>0.05;2.The influence of the number of involved segments on the diameter of the left atrium and the end-diastolic diameter of the left ventricle,between each group,P>0.05,no statistical difference.3.The effect of the number of involved segments on the left ventricular ejection fraction.Comparison between the two groups assumes that the number of involved segments has no effect on the left ventricular ejection fraction.The test results show P>0.05,and the null hypothesis is retained.4.Patients aged >50 years with more than two kinds of ECG changes more,P>0.05,no statistical significance.Conclusion: Patients with myocardial compaction are more common in men,and the clinical manifestations are mainly symptoms of heart failure.NYHA heart function classification Ⅲ/Ⅳ is the reason for patients’ repeated admissions.