Background Morphological and functional cardiac involvement is rarely seen in inflammatory bowel disease (IBD) patients but there is evidence that IBD patients have an increased risk of cardiovascular events despite the lower prevalence of traditional cardiovascular (CV) risk factors when compared to the general population. Our systematic review and meta-analysis examined the relationship between IBD and cardiac function, namely incidence of heart failure (HF) and clinical and subclinical echocardiographic changes. Methods Two medical databases, PubMed and Scopus, were systematically searched up to September 2022 to identify all studies reporting heart failure and/or echocardiographic changes in IBD patients. Results We identified 1287 original papers and included 18 in our qualitative analysis. Through analysis of echocardiographic data, we found subtle systolic and diastolic changes in IBD patients. We also found higher vascular dysfunction with increased aortic stiffness, coronary microvascular dysfunction resulting in worse cardiovascular outcomes. This group had an increased risk for HF hospitalizations compared with general population. We have also performed a meta-analysis with 9 studies which included echocardiographic data. In the IBD population we found reduced E/A ratio (Std. MD -0.51, 95% CI: -1.00 to -0.02, p = 0.04, I2 = 87%, p<0.0001), higher values of E/E’ ratio (Std. MD 1.46, 95% CI: 0.86 to 2.07, p<0.00001, I2 = 80%, p=0.02). We evaluated left ventricular function using longitudinal global strain which was decreased in IBD patients (Std. MD 0.66, 95% CI: 0.48 to 0.84, p<0.00001, I2 = 0%, p= 0.55). Overall IBD patients had increased LA diameter (Std. MD 0.06, 95% CI: 0.12 to 0.24, p = 0.50, I2 = 20%), and an increased LA area (Std. MD 0.03, 95% CI: 0.24 to 0.29, p = 0.85, I2 = 0%), but no statistical significance was not reached. A significant increase in inter-atrial and right intra-atrial conduction delay was observed in IBD patients (Std. MD 0.88, 95% CI: 0.45 to 1.31, p<0.0001, I2 = 42%; Std. MD 0.9, 95% CI: 0.57 to 1.22, p < 0.00001, I2 = 0%, respectively). We found no significant bias in our analysis using CASP checklist. Conclusion There is significant evidence to conclude that the IBD population has increased risk for LV and atrial dysfunction, vascular changes, arrhythmias, and heart failure hospitalization. Screening with sensitive imaging like speckle tracking echocardiography could identify early subclinical changes. IBD is in fact a cardiovascular risk factor and tight inflammation control may reduce the risk.

中文翻译：

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P222 炎症性肠病和心脏功能：通过荟萃分析对文献进行系统回顾

背景 形态学和功能性心脏受累在炎症性肠病 (IBD) 患者中很少见，但有证据表明，尽管与普通人群相比，传统心血管 (CV) 危险因素的患病率较低，但 IBD 患者心血管事件的风险增加。我们的系统回顾和荟萃分析检查了 IBD 与心脏功能之间的关系，即心力衰竭 (HF) 的发生率以及临床和亚临床超声心动图变化。方法 系统检索截至 2022 年 9 月的两个医学数据库 PubMed 和 Scopus，以识别报告 IBD 患者心力衰竭和/或超声心动图变化的所有研究。结果 我们确定了 1287 篇原始论文，并在定性分析中纳入了 18 篇。通过超声心动图数据分析，我们发现IBD患者存在细微的收缩压和舒张压变化。我们还发现，随着主动脉僵硬度的增加，血管功能障碍增多，冠状动脉微血管功能障碍导致心血管结局更差。与一般人群相比，该群体因心力衰竭住院的风险增加。我们还对 9 项研究进行了荟萃分析，其中包括超声心动图数据。在 IBD 人群中，我们发现 E/A 比率降低（标准 MD -0.51，95% CI：-1.00 至 -0.02，p = 0.04，I2 = 87%，p<0.0001），E/E' 比率值较高(标准MD 1.46，95％CI：0.86至2.07，p＜0.00001，I2＝80％，p＝0.02)。我们使用 IBD 患者中降低的纵向整体应变来评估左心室功能（标准 MD 0.66，95% CI：0.48 至 0.84，p<0.00001，I2 = 0%，p= 0.55）。总体而言，IBD 患者的 LA 直径增加（标准 MD 0.06，95% CI：0.12 至 0.24，p = 0.50，I2 = 20%），并且 LA 面积增加（标准 MD 0.03，95% CI：0.24 至 0.29， p = 0.85，I2 = 0%），但未达到统计学显着性。IBD 患者心房间和右心房内传导延迟显着增加（标准 MD 0.88，95% CI：0.45 至 1.31，p<0.0001，I2 = 42%；标准 MD 0.9，95% CI ：0.57至1.22，p＜0.00001，I2＝0％，分别)。我们发现使用 CASP 检查表进行的分析没有显着偏差。结论 有重要证据表明，IBD 人群发生左心室和心房功能障碍、血管变化、心律失常和心力衰竭住院的风险增加。使用斑点追踪超声心动图等敏感成像进行筛查可以识别早期亚临床变化。IBD 实际上是心血管危险因素，严格的炎症控制可能会降低风险。