关键词: 肥厚型梗阻性心肌病, 经皮心内膜室间隔射频消融术, Meta分析

Abstract: Objective We conducted a meta-analysis to systematically evaluate the clinical efficacy of endocardial radiofrequency ablation of septal hypertrophy(ERASH)for the treatment of hypertrophic obstructive cardiomyopathy(HOCM). Methods Relevant literature was retrieved from PubMed,the Cochrane Library,Embase,CNKI,VIP and Wanfang Data,with the search period spanning from the inception of each database to June 2024.JBI scale was used to evaluate literature quality.Continuous data were described using weighted mean difference(WMD)and 95% confidence interval(CI).Meta-analysis was performed using Stata 18.0 software. Results A total of 11 singlearm clinical studies involving 231 patients with HOCM were included,with a mean age of 51.27 years.The results of the meta-analysis showed that at the final follow-up after ERASH intervention,the resting and provoked left ventricular outflow tract pressure gradient(LVOTPG)was significantly reduced by 61.13 mmHg[95%CI(40.68,82.58),P<0.01]and 91.91 mmHg[95%CI(71.43,112.39),P<0.01],respectively,compared with preoperative levels.The New York Heart Association(NYHA)functional class at the final follow-up decreased by 1.70[95%CI(1.53,1.88),P<0.01]relative to baseline.In addition,the total 6-minute walking distance at the final follow-up was significantly increased by 103.75 m compared with baseline(95%CI:-167.45,-40.05,P=0.01).Plasma brain natriuretic peptide(BNP)levels were markedly decreased by 786.55 pg/mL at the final follow-up(95%CI:724.50,848.60,P<0.01).Nevertheless,the interventricular septum thickness(IVST)at the final follow-up showed no statistically significant difference compared with baseline(P=0.23).Subgroup analysis based on follow-up duration(6 months vs.over 6 months)demonstrated that ERASH intervention significantly reduced resting LVOTPG and improved 6-minute walking distance in both subgroups(all P<0.01). Conclusion ERASH is effective in the treatment of patients with HOCM.However,further large-scale randomized controlled trials are still required to verify these findings.

Key words: hypertrophic obstructive cardiomyopathy, endocardial radiofrequency ablation of septal hypertrophy, Meta-analysis