Meta-analysis indicated that tricuspid annular plane systolic excursion, myocardial performance index, MPI, FAC, PAAT, and PAAT/RVET have predictive value for BPD in preterm infants, and subgroup analyses showed that measurements obtained before 36 weeks’ postmenstrual age had better predictive performance than measurements obtained at 36 weeks’ PMA.
Abstract
Background: To comprehensively determine whether echocardiographic measures of right-sided cardiac performance can identify premature neonates at risk of developing bronchopulmonary dysplasia. Methods: We systematically queried 4 electronic databases – PubMed, Embase, the Cochrane Library, and Web of Science – from their respective launch dates through April 2025 to retrieve eligible studies examining whether echocardiographic markers of right-sided cardiac performance could anticipate bronchopulmonary dysplasia in premature neonates. Study rigor was evaluated with the Newcastle–Ottawa Scale, while the review was designed and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance and the Cochrane Handbook. Pooled effect estimates were calculated in RevMan 5.3, whereas sensitivity analyses and Egger regression test were performed with Stata/SE 15.1. Results: Twelve studies were incorporated, involving 1316 preterm infants, with 414 of them diagnosed with bronchopulmonary dysplasia (BPD). Meta-analysis indicated that tricuspid annular plane systolic excursion (TAPSE) (weighted mean difference [WMD] = −0.08, 95% confidence interval [CI] −0.12 to −0.04, P = .0002), myocardial performance index (MPI) (WMD = 0.05, 95% CI 0.02–0.08, P = .004), fractional area change (FAC) (WMD = −3.51, 95% CI −6.68 to −0.33, P = .03), pulmonary artery acceleration time (PAAT) (WMD = −6.54, 95% CI −10.71 to −2.37, P = .002), and PAAT to right ventricular ejection time ratio (PAAT/RVET) (WMD = −0.04, 95% CI −0.07 to −0.01, P = .005) can aid BPD prediction. Subgroup analyses showed that measurements obtained before 36 weeks’ postmenstrual age (PMA) had better predictive performance for TAPSE, MPI, and FAC than measurements obtained at 36 weeks’ PMA. PAAT/RVET remained predictive of BPD both before 36 weeks’ PMA and at 36 weeks’ PMA. Among infants with birth weight ≥1000 g, MPI demonstrated better predictive performance for BPD. Sensitivity analyses (leave-one-out) showed that exclusion of individual studies had no meaningful effect on the summary estimates, supporting the stability of the results. Conclusion: TAPSE, MPI, FAC, PAAT, and PAAT/RVET have predictive value for BPD in preterm infants.
Weaning failure in mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) remains a critical ICU challenge that substantially increases mortality. Although point-of-care diaphragmatic ultrasound is widely proposed to guide weaning decisions, its diagnostic accuracy remains uncertain, and the optimal parameter for this high-risk population has yet to be established. We systematically searched eight databases through April 5, 2026, for studies evaluating diaphragmatic ultrasound for predicting weaning outcomes in AECOPD. After methodological quality was appraised with the QUADAS-2 tool. Pooled sensitivity, specificity, positive and negative likelihood ratios (LR + and LR−), and diagnostic odds ratios were estimated using bivariate random-effects models, and overall diagnostic performance was summarized by the area under the summary receiver operating characteristic curve. Fagan nomograms were constructed to illustrate changes from pre-test to post-test probability. Threshold effects and heterogeneity were assessed using Spearman correlation and the Q test with the I² statistic, respectively. Exploratory meta-regression, leave-one-out sensitivity analyses, and Deeks’ test were used to investigate sources of heterogeneity, assess result stability, and evaluate funnel-plot asymmetry. Twenty-three studies comprising 2,000 patients (1,310 successes, 690 failures) were included. Of 14 distinct ultrasound parameters identified, four provided sufficient data for quantitative synthesis. Diaphragmatic excursion (DE, n = 16) showed the most robust and balanced performance, with a pooled sensitivity of 0.85, specificity of 0.85, and an AUC of 0.92. Diaphragm thickening fraction (DTF, n = 13) also showed good accuracy (sensitivity 0.84, specificity 0.77, AUC 0.88). The diaphragmatic rapid shallow breathing index (D-RSBI, n = 8) showed high specificity (0.88) but moderate sensitivity (0.74; AUC 0.85), whereas diaphragmatic contraction velocity (DCV, n = 4) showed only moderate accuracy (AUC 0.70). Substantial heterogeneity was observed for DE, DTF, and D-RSBI. Diaphragm ultrasound, particularly DE, may provide useful prognostic information for weaning outcomes in mechanically ventilated patients with AECOPD, while D-RSBI may help identify patients at high risk of weaning failure. However, given the small, predominantly single-centre studies, post hoc study-specific thresholds, substantial heterogeneity, and geographical concentration of the evidence, these findings represent apparent prognostic performance rather than externally validated diagnostic accuracy. Diaphragm ultrasound should therefore be used as an adjunct rather than the sole basis for weaning decisions, pending multicentre external validation and interventional trials demonstrating improved patient-important outcomes.
Xiaoqing Zhou, Yingnan Xu, Qianjun Yan et al.· Critical Care· 1 citation· ⚡1
AIM
An updated meta-analysis targeting the prevalence of left ventricular hypertrophy (LVH), a cardinal marker of hypertensive heart disease (HHD), over the last 15 years is lacking. Thus, we analyzed the literature in order to provide a comprehensive information on LVH prevalence, as assessed by echocardiography, in the hypertensive setting.
METHODS
The PubMed, OVID-MEDLINE, and Cochrane Library databases were analyzed to search English-language articles published from 1 January 2011 up to 31 December 2025. Studies were identified by using MeSH terms and crossing the following search items: 'left ventricular hypertrophy', 'left ventricular mass', 'hypertensive heart disease', 'echocardiography', 'hypertension', and 'subclinical cardiac damage'.
RESULTS
A total of 51 studies including 74 632 hypertensive patients were considered. Overall, the prevalence of LVH in the pooled cohort, defined according to criteria recommended by echocardiographic guidelines, was 36.6% (95% CI: 33.4-40%). Data provided by 18 studies (n = 40 108 patients) showed that the probability of having LVH was lower in men than in women (OR = 0.62, CI: 0.48-0.80, P < 0.0001). Among patients with LVH (17 studies), the risk of concentric LVH was almost twice as high as eccentric (OR = 1.94, CI: 1.52-2.49, P < 0.0001).
CONCLUSION
Our meta-analysis suggests that the high contemporary prevalence of LVH reflects the failure of therapeutic strategies worldwide in the prevention and treatment of HHD. From a clinical perspective, these data imply the need for a more aggressive treatment of hypertension and related cardiovascular risk factors leading to LVH, especially in women.
E. Gherbesi, Andrea Faggiano, Carla Sala et al.· Journal of Hypertension· 0 citations
OBJECTIVES
To assess the effectiveness and safety of active pharmacotherapy for patent ductus arteriosus (PDA) initiated based on echocardiography-criteria versus expectant management in extremely preterm infants <29 w gestation in the first three weeks of life.
STUDY DESIGN
Systematic review with meta-analysis and trial sequential analysis (TSA). We searched PubMed, Embase, CENTRAL and Emcare for randomised trials published between 2010 and May 2026. We synthesised results using random-effects meta-analysis and conducted a TSA.
PATIENTS
Extremely preterm infants with PDA considered as significant on echocardiography.
INTERVENTIONS
Pharmacotherapy versus expectant management.
MAIN OUTCOME MEASURES
Mortality by 36 weeks postconceptional age or before discharge and chronic lung disease (CLD).
RESULTS
We included 12 trials involving 2344 extremely preterm infants. Meta-analysis found increased risk of mortality with active pharmacotherapy (RR 1.34, 95% CI 1.08 to 1.67; p=0.008, I2=0%; 12 randomised controlled trials (RCTs)). Number-needed-to-treat for an additional harmful outcome (i.e. mortality) was 25 (95% CI 17 to 100). On TSA conducted with the stringent alpha error 3.3% and beta 10%, the cumulative Z-score touched the O'Brien-Fleming monitoring boundary at the current sample size, supporting the meta-analysis findings under the specified TSA assumptions.For CLD, meta-analysis showed little or no difference (RR 0.99, 95% CI 0.92 to 1.06, p=0.74, I2=14%, 12 RCTs). The certainty of evidence was high for mortality and moderate for CLD.
CONCLUSIONS
In extremely preterm infants, active pharmacotherapy for PDA based on current echocardiographic criteria in the first three weeks of life was associated with increased mortality with a clinically important number needed to harm. These findings should inform treatment decisions and discussions with parents while ongoing research seeks to identify infants who may benefit from treatment.
PROSPERO REGISTRATION NUMBER
CRD420261303992.
Shripada C Rao, C. Rath, S. Patole· Archives of Disease in Child...· 0 citations
Objective To systematically evaluate the predictive value of abnormal uteroplacental and fetal Doppler indices for adverse perinatal outcomes in patients with hypertensive disorders of pregnancy (HDP), quantify the strength of association, and assess the certainty of evidence to optimize prenatal monitoring protocols. Methods Based on PRISMA guidelines, we searched Cochrane CENTRAL, PubMed, Embase, and SCIE for observational cohort studies published between January 2016 and March 2026. Included studies comprised singleton pregnant women with HDP who underwent uteroplacental and fetal Doppler assessment (e.g., UtA-PI, UA, MCA, or CPR) and reported perinatal outcomes. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS), and the certainty of evidence was graded using the GRADE framework. This study was registered with PROSPERO (CRD420261331863). Results Thirteen cohort studies involving 1,744 patients (25 independent datasets) were included. Meta-analysis revealed that HDP patients with abnormal uteroplacental and fetal Doppler indices had a significantly elevated risk of adverse perinatal outcomes (RR = 2.26, 95% CI: 1.93–2.64, P < 0.001). Subgroup analysis indicated that an abnormal Uterine Artery Pulsatility Index (UtA-PI) was a robust predictor (RR = 2.96, 95% CI: 2.26–3.89, P < 0.001, I2 = 6%). An abnormal Cerebroplacental Ratio (CPR) also indicated an increased risk (RR = 1.92, 95% CI: 1.58–2.33, P < 0.001), though with substantial heterogeneity (I2 = 73.0%). GRADE assessment graded the certainty of evidence as “Moderate” for the UtA-PI subgroup and “Low” for the CPR subgroup. Conclusion Abnormal uteroplacental and fetal Doppler indices, particularly UtA-PI and CPR, are strongly associated with adverse perinatal outcomes in HDP patients. UtA-PI serves as a stable mid-trimester risk-stratification tool, while CPR functions as a valuable supplementary index in the third trimester. We recommend a multi-parametric, sequential monitoring workflow for HDP management. Future research should prioritize establishing standardized, gestational-age-specific diagnostic thresholds for CPR to enhance clinical precision. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261331863, identifier CRD420261331863.
Peng Zhou, Zhong-Feng Tang, Si-Yuan Li et al.· Frontiers in Medicine· 0 citations
ABSTRACT Objective We conducted a systematic review and prognostic meta‐analysis to evaluate the association between ultrasound‐derived measures of diaphragm structure and contractile activity with the risk of extubation failure in mechanically ventilated neonates. Data Sources MEDLINE, Embase, the Cochrane Library, CINAH, Scopus, and ClinicalTrials.gov were systematically searched from inception to January 12, 2026, without using language restrictions. Study Selection Observational studies including mechanically ventilated neonates (≤ 28 days old) undergoing planned extubation in whom diaphragmatic thickness, thickening fraction, or excursion were measured by ultrasound and extubation outcome were reported. Studies involving congenital diaphragmatic or neuromuscular disorders were excluded. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Random‐effects meta‐analyses were conducted using mean differences (MD) with 95% confidence intervals (CI). Results Of 1,522 records identified, 110 full‐text articles were assessed, and seven prospective cohort studies (n = 255 neonates) met the inclusion criteria. Extubation failure occurred in 90 neonates (35%). Neonates who failed extubation had significantly lower diaphragm thickening fraction compared with those successfully extubated (MD = −9.51%; 95% CI: −14.73 to −4.29; p = 0.0004; I2 = 0%). Differences in diaphragm thickness and excursion were not statistically significant. Overall risk of bias was moderate to high, primarily due to inadequate adjustment for confounding and variability in outcome definitions. Conclusions Lower diaphragm thickening fraction is associated with extubation failure in mechanically ventilated neonates. Standardization of measurement protocols and prospective validation studies are needed before diaphragm ultrasound can be incorporated into routine extubation decision‐making. REGISTRATION PROSPERO CRD420251045024.
M. Sousa, Eleonora Balzani, S. Dubó et al.· Pediatric Pulmonology· 0 citations
BACKGROUND
Permanent pacemaker implantation is required in up to 25% of patients after transcatheter aortic valve replacement (TAVR). Conventional right ventricular pacing (RVP) may promote dyssynchrony, whereas conduction system pacing (CSP) preserves physiological activation.
RESEARCH QUESTION
Does CSP improve clinical, echocardiographic, electrical, and procedural outcomes compared with RVP in patients requiring pacing after TAVR?
METHODS
We conducted a PROSPERO-registered systematic review and meta-analysis following PRISMA 2020. PubMed, Embase, Scopus, and ClinicalTrials.gov were searched through June 2026 for randomized and comparative observational studies of CSP versus RVP after TAVR. Random-effects models generated risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs). Prediction intervals, cumulative meta-analysis, leave-one-out analyses, and GRADE assessment were performed.
RESULTS
Six studies, one randomized trial and five observational studies, enrolled 675 patients (CSP, n = 344; RVP, n = 331). CSP was associated with fewer heart-failure hospitalizations (RR 0.49, 95% CI 0.29-0.83; p = 0.017; I2 = 5%) and shorter paced QRS duration (MD -31.05 ms, 95% CI -34.07 to -28.02; p < 0.001; I2 = 0%). All-cause mortality, cardiovascular death, and change in left ventricular ejection fraction did not differ significantly. Implantation success was modestly lower with CSP (RR 0.91; p = 0.014).
CONCLUSION
CSP was associated with fewer heart-failure hospitalizations and shorter paced QRS duration than RVP after TAVR. Evidence was predominantly observational, and no significant differences were demonstrated in mortality or change in left ventricular ejection fraction. The potential clinical relevance of CSP when a high ventricular pacing burden is anticipated remains plausible but was not directly demonstrated by the available data; adequately powered randomized trials are required before routine adoption.
R. Shakeel, A. Uddin, D. Ladhani et al.· Pacing and clinical electrop...· 0 citations
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