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Meta-analysis
Original research article
Left ventricular longitudinal systolic function analysed by 2D speckle-tracking echocardiography in heart failure with preserved ejection fraction: a meta-analysis
  1. Daniel Armando Morris1,
  2. Xin-Xin Ma2,
  3. Evgeny Belyavskiy1,
  4. Radhakrishnan Aravind Kumar1,
  5. Martin Kropf1,
  6. Robin Kraft1,
  7. Athanasios Frydas1,
  8. Engin Osmanoglou3,
  9. Esteban Marquez4,
  10. Erwan Donal5,
  11. Frank Edelmann1,
  12. Carsten Tschöpe1,
  13. Burkert Pieske1,6 and
  14. Elisabeth Pieske-Kraigher1
  1. 1Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, DZHK (German Centre for Cardiovascular Research) partner site Berlin and Berlin Institute of Health (BIH), Berlin, Germany
  2. 2Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
  3. 3Department of Internal Medicine and Cardiology, Meoclinic, Berlin, Germany
  4. 4Department of Radiology, Private Clinic of Radiology (Q-Diagnostica—Scanner Murcia), Murcia, Spain
  5. 5Department of Cardiology, CHU Rennes, Pontchaillou Hospital, Rennes, France
  6. 6Department of Internal Medicine and Cardiology, German Heart Institute, Berlin, Germany
  1. Correspondence to Dr Daniel Armando Morris, Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany; daniel-armando.morris{at}charite.de

Abstract

Background The purpose of this meta-analysis was to confirm if the global longitudinal systolic function of the left ventricle (LV) is altered in patients with heart failure with preserved ejection fraction (HFpEF).

Methods We searched in different databases (Medline, Embase and Cochrane) studies that analysed LV global longitudinal systolic strain (GLS) in patients with HFpEF and in controls (such as healthy subjects or asymptomatic patients with arterial hypertension, diabetes mellitus or coronary artery disease).

Results Twenty-two studies (2284 patients with HFpEF and 2302 controls) were included in the final analysis. Patients with HFpEF had significantly lower GLS than healthy subjects (mean −15.7% (range −12% to −18.9%) vs mean −19.9% (range −17.1% to −21.5%), weighted mean difference −4.2% (95% CI −3.3% to −5.0%), p < 0.001, respectively). In addition, patients with HFpEF had also significantly lower GLS than asymptomatic patients (mean −15.5% (range −13.4% to −18.4%) vs mean −18.3% (range −15.1% to −20.4%), weighted mean difference −2.8%(95% CI −1.9% to −3.6%), p < 0.001, respectively). In line, 10 studies showed that the rate of abnormal GLS was significantly higher in patients with HFpEF (mean 65.4% (range 37%–95%)) than in asymptomatic subjects (mean 13% (range 0%–29.6%)). Regarding the prognostic relevance of abnormal GLS in HFpEF, two multicentre studies with large sample size (447 and 348) and high number of events (115 and 177) showed that patients with abnormal GLS had worse cardiovascular (CV) outcomes than those with normal GLS (HR for CV mortality and HF hospitalisation 2.14 (95% CI 1.26 to 3.66) and 1.94 (95% CI 1.22 to 3.07)), even adjusting these analyses for multiples clinical and echocardiographic variables.

Conclusion The present meta-analysis analysing 2284 patients with HFpEF and 2302 controls confirms that the longitudinal systolic function of the LV is significantly altered in high proportion of patients with HFpEF. Further large multicentre studies with the aim to confirm the prognostic role of abnormal GLS in HFpEF are warranted.

  • heart failure
  • strain
  • echocardiography
  • speckle-tracking

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2017-000630

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    Footnotes

    • Dr Morris and Dr Ma contributed equally to this study.

    • Contributors All authors have contributed significantly to this study and meet the criteria for authorship.

    • Competing interests None declared.

    • Patient consent Obtained in all studies.

    • Ethics approval Charite University Hospital.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There are no additional data available for this paper.