Dataset Information

Global longitudinal strain as a prognostic marker in cardiac resynchronisation therapy: A systematic review.

ABSTRACT:

Purpose

Cardiac resynchronisation therapy (CRT) has proven mortality benefits for heart failure patients with moderate to severe systolic left ventricular dysfunction and evidence of a left bundle branch block. Determining responders to this therapy can be difficult due to the presence of myocardial fibrosis and scar. Left ventricular global longitudinal strain (LV GLS) is a robust and sensitive measure of myocardial function and fibrosis that has significant prognostic value for a plethora of cardiac pathologies. Our aim was to perform a systematic review of the value of LV GLS for predicting outcomes in patients undergoing CRT.

Methods

A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) protocol for reporting on systematic reviews and meta-analyses. An electronic search of all English, adult publications in EMBASE, MEDLINE/PubMed and the Cochrane Database of Systematic reviews was undertaken.

Results

The search yielded, 9 studies that included 3,981 patients with symptomatic heart failure, undergoing CRT implantation with LV GLS utilised as a predictor of all-cause mortality, cardiovascular death, rehospitalisation, LVAD implantation/ heart transplantation or left ventricular reverse remodelling. Significant heterogeneity was observed in study outcome measures, included populations, LV-GLS cut-offs and follow-up definitions, resulting in the inability to reliably conduct a meta-analyses. Overall, pre-CRT LV GLS was found to be a predictor of outcome post CRT insertion.

Conclusions

In conclusion, all studies implied that incrementally abnormal baseline LV GLS pre-CRT implantation was associated with a long term poorer outcome.

SUBMITTER: Appadurai V

PROVIDER: S-EPMC8342974 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundsThe presence of impaired global longitudinal strain (GLS) may be a valuable bio-marker in the early diagnosis for left ventricle (LV) impairment, which would help scrutinize asymptomatic aortic stenosis (AS) patients with high risk of adverse outcomes, such as major adverse cardiovascular events (MACE).MethodsThe study was prospectively registered in PROPSERO (CRD 42021223472). Databases, such as Pubmed, Embase, Cochrane Library, Web of science, and Scopus were searched for studies evaluating the impact of impaired GLS on MACE, all-cause mortality, and aortic valve replacement (AVR) in asymptomatic AS. Hazard ratios (HRs) with 95% CIs were calculated with meta-analysis for binary variants. Meta-regression, subgroup analysis, and sensitivity analyses were applied as needed to explore the heterogeneity.ResultsEventually, a total of nine studies reporting 1,512 patients were enrolled. Compared with the normal GLS group, impaired GLS significantly increased MACE (HR = 1.20, 95% CI: 1.10-1.30, I 2 = 79%) with evident heterogeneity, all-cause mortality (HR = 1.42, 95% CI: 1.24-1.63), and AVR (HR = 1.17, 95% CI: 1.07-1.28). Subgroup analyses stratified by left ventricular ejection fraction (LVEF) > 50% or LVEF without precise cut-off point found that compared with the normal GLS group, impaired GLS remarkably increased MACE both in two subgroups (LVEF > 50%: HR: 1.22, 95% CI: 1.05-1.50; LVEF without cutpoint: HR: 1.25, 95% CI: 1.05-1.50). The results stratified by AS severity (mild/moderate and severe) or follow-up time resembled those stratified by LVEF. In addition, when subgroup analysis was stratified by mean aortic valve pressure gradient (MG ≥ 40 mm Hg and MG <40 mm Hg), compared with normal GLS, impaired GLS significantly increased MACE both in two subgroups (MG ≥ 40 mm Hg: HR: 3.41, 95% CI: 1.64-7.09; MG below 40 mm Hg: HR: 3.17, 95% CI: 1.87-5.38). Moreover, the effect sizes here were substantially higher than those in the former two stratified factors.ConclusionsThe presence of impaired GLS substantially worsens the outcomes for adverse cardiovascular events in asymptomatic patients with AS regardless of LVEF or AS severity or follow-up time or mean aortic valve pressure gradient, which highlights the importance of incorporating impaired GLS into risk algorithms in asymptomatic AS.Systematic review registrationPROSPERO (registration number: CRD42021223472).

Project description:Importance:Echocardiographic left ventricular global longitudinal strain (GLS) detects early subclinical ventricular dysfunction and can be used in patients receiving potentially cardiotoxic chemotherapy. A meta-analysis of the prognostic value of GLS for cancer therapy-related cardiac dysfunction (CTRCD) has not been performed, to our knowledge. Objective:To explore the prognostic value of GLS for the prediction of CTRCD. Data Sources:Systematic search of the MEDLINE, Embase, Scopus, and the Cochrane Library databases from database inception to June 1, 2018. Study Selection:Cohort studies assessing the prognostic or discriminatory performance of GLS before or during chemotherapy for subsequent CTRCD. Data Extraction and Synthesis:Random-effects meta-analysis and hierarchical summary receiver operating characteristic curves (HSROCs) were used to summarize the prognostic and discriminatory performance of different GLS indices. Publication bias was assessed using the Egger test, and meta-regression was performed to assess sources of heterogeneity. Main Outcomes and Measures:The primary outcome was CTRCD, defined as a clinically significant change in left ventricular ejection fraction with or without new-onset heart failure symptoms. Results:Analysis included 21 studies comprising 1782 patients with cancer, including breast cancer, hematologic malignancies, or sarcomas, treated with anthracyclines with or without trastuzumab. The incidence of CTRCD ranged from 9.3% to 43.8% over a mean follow-up of 4.2 to 23.0 months (pooled incidence, 21.0%). For active treatment absolute GLS (9 studies), the high-risk cutoff values ranged from -21.0% to -13.8%, with worse GLS associated with a higher CTRCD risk (odds ratio, 12.27; 95% CI, 7.73-19.47; area under the HSROC, 0.86; 95% CI, 0.83-0.89). For relative changes vs a baseline value (9 studies), cutoff values ranged from 2.3% to 15.9%, with a greater decrease linked to a 16-fold higher risk of CTRCD (odds ratio, 15.82; 95% CI, 5.84-42.85; area under the HSROC, 0.86; 95% CI, 0.83-0.89). Both indices showed significant publication bias. Meta-regression identified differences in sample size and CTRCD definition but not GLS cutoff value as significant sources of interstudy heterogeneity. Conclusions and Relevance:In this meta-analysis, measurement of GLS after initiation of potentially cardiotoxic chemotherapy with anthracyclines with or without trastuzumab had good prognostic performance for subsequent CTRCD. However, risk of bias in the original studies, publication bias, and limited data on the incremental value of GLS and its optimal cutoff values highlight the need for larger prospective multicenter studies.