Imaging and Circulating Biomarker-Defined Cardiac Pathology in Pulmonary Tuberculosis: A Systematic Review.

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Global Heart Pub Date : 2024-11-08 eCollection Date: 2024-01-01 DOI:10.5334/gh.1369

Marcello S Scopazzini, Katherine J Hill, Edith D Majonga, Dominik Zenner, Helen Ayles, Anoop S V Shah

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Abstract

Background: Pulmonary tuberculosis (PTB) is associated with increased cardiovascular disease (CVD) mortality. However, underlying pathophysiological mechanisms are poorly understood. This systematic review aims to synthesise the evidence on the prevalence of cardiac pathology based on cardiac imaging and circulating biomarkers in patients with PTB.

Methods: We systematically searched databases for studies in patients with PTB evaluating cardiac pathology (pericardial effusion or left ventricular dysfunction) on echocardiography; late gadolinium enhancement on cardiac magnetic resonance imaging (CMR); myocardial inflammation on positron-emission tomography (PET); coronary artery stenosis on CT coronary angiography (CTCA); and cardiac troponin (cTn) and/or B-type natriuretic peptides (BNP) assessment.

Results: Seven studies were included across 1,333 participants with PTB. Four studies used echocardiography (n = 1,111). The prevalence of pericardial effusion ranged from 14.1-55.9%; and left ventricular systolic impairment from 0-4.25%. One study used CMR and PET-CT (n = 26); and two studies used PET-CT alone (n = 196). The prevalence of pericardial and/or myocardial inflammation ranged from 0.6-21.8%. One study evaluated cTn, Creatine Kinase-MB (CK-MB), and BNP (n = 800), of whom 246 had raised cTn. No study reported cardiac pathology using CTCA.

Conclusion: Pericardial effusion is the commonest reported cardiac pathology in PTB. To date, only one study has evaluated cardiac biomarkers and studies evaluating myocardial or coronary disease on advanced imaging remain limited. Our study highlights the paucity of evidence on the presence of cardiac pathology in PTB. Studies are required to determine the prevalence of, and disease mechanisms associated with cardiac pathology among patients with PTB.

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肺结核的成像和循环生物标记物定义的心脏病理学：系统性综述。

背景：肺结核（PTB）与心血管疾病（CVD）死亡率增加有关。然而，人们对其潜在的病理生理机制知之甚少。本系统性综述旨在根据肺结核患者的心脏成像和循环生物标志物，综合分析有关心脏病变发生率的证据：我们在数据库中系统检索了有关 PTB 患者的研究，这些研究评估了超声心动图上的心脏病变（心包积液或左心室功能障碍）；心脏磁共振成像（CMR）上的晚期钆增强；正电子发射断层扫描（PET）上的心肌炎症；CT 冠状动脉造影（CTCA）上的冠状动脉狭窄；以及心肌肌钙蛋白（cTn）和/或 B 型钠尿肽（BNP）评估。结果：共纳入七项研究，涉及 1,333 名 PTB 患者。四项研究使用了超声心动图（n = 1,111）。心包积液的发生率从 14.1% 到 55.9%；左心室收缩功能损害的发生率从 0% 到 4.25%。一项研究使用了 CMR 和 PET-CT（n = 26）；两项研究仅使用了 PET-CT（n = 196）。心包和/或心肌炎症的发生率为 0.6-21.8%。一项研究评估了 cTn、肌酸激酶-MB (CK-MB) 和 BNP（n = 800），其中 246 人的 cTn 升高。没有研究使用 CTCA 报告心脏病理：结论：心包积液是 PTB 中最常见的心脏病变。迄今为止，只有一项研究对心脏生物标志物进行了评估，而通过高级成像对心肌或冠状动脉疾病进行评估的研究仍然有限。我们的研究凸显了 PTB 中存在心脏病变的证据之匮乏。需要进行研究以确定 PTB 患者中心脏病变的患病率和相关疾病机制。

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来源期刊

Global Heart Medicine-Cardiology and Cardiovascular Medicine

CiteScore

5.70

自引率

5.40%

发文量

审稿时长

5 weeks

期刊介绍： Global Heart offers a forum for dialogue and education on research, developments, trends, solutions and public health programs related to the prevention and control of cardiovascular diseases (CVDs) worldwide, with a special focus on low- and middle-income countries (LMICs). Manuscripts should address not only the extent or epidemiology of the problem, but also describe interventions to effectively control and prevent CVDs and the underlying factors. The emphasis should be on approaches applicable in settings with limited resources. Economic evaluations of successful interventions are particularly welcome. We will also consider negative findings if important. While reports of hospital or clinic-based treatments are not excluded, particularly if they have broad implications for cost-effective disease control or prevention, we give priority to papers addressing community-based activities. We encourage submissions on cardiovascular surveillance and health policies, professional education, ethical issues and technological innovations related to prevention. Global Heart is particularly interested in publishing data from updated national or regional demographic health surveys, World Health Organization or Global Burden of Disease data, large clinical disease databases or registries. Systematic reviews or meta-analyses on globally relevant topics are welcome. We will also consider clinical research that has special relevance to LMICs, e.g. using validated instruments to assess health-related quality-of-life in patients from LMICs, innovative diagnostic-therapeutic applications, real-world effectiveness clinical trials, research methods (innovative methodologic papers, with emphasis on low-cost research methods or novel application of methods in low resource settings), and papers pertaining to cardiovascular health promotion and policy (quantitative evaluation of health programs.