Prognostic value of strain echocardiography measurements in patients with non-ischemic cardiomyopathy

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Speckle tracking echocardiography has been increasingly used in the evaluation of myocardial function. However, the association of reduced strain measurements with cardiovascular outcomes remains unclear in patients with nonischemic cardiomyopathy (NICM). Purpose The purpose of this meta-analysis is to evaluate the prognostic value of speckle tracking echocardiography in patients with NICM. Methods A literature search was conducted for studies reporting on the association of left ventricular global longitudinal strain (LVGLS), left ventricular global circumferential strain (LVGCS), left ventricular global radial strain (LVGRS), and right ventricular global longitudinal strain (RVGLS) on baseline echocardiography with cardiovascular outcomes on long term follow-up in patients with NICM. The primary endpoint was major adverse cardiac events (MACE). Secondary endpoints included left ventricular reverse remodeling (LVRR) and ventricular arrhythmias (VA). The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. Results A total of 17 studies with 2375 participants (640 with adverse outcomes and 1735 without adverse outcomes) met inclusion criteria. Mean follow-up duration was 33 months. Mean ejection fraction was 30%. Baseline LVGLS, LVGCS, LVGRS, and RVGLS were significantly lower in NICM patients who subsequently experienced MACE on follow-up compared to patients without MACE (SMD −0.57, 95% CI −0.82, −0.32; p<0.01; SMD −0.54, 95% CI −0.75, −0.33; p<0.01; SMD −0.51, 95% CI −0.7, −0.32; p<0.01; SMD −0.46, 95% CI −0.75, −0.18; p<0.01). Baseline LVGLS was significantly higher in patients who experienced LVRR on follow-up compared to patients without LVRR (SMD 0.36, 95% CI 0.05–0.68; p = 0.02). Baseline LVGLS was significantly lower in NICM patients who experienced VA on follow-up (SMD −1.19, 95% CI −2.12, −0.26, p = 0.01). Conclusions Speckle tracking echocardiography may represent a useful clinical tool for risk stratification of NICM patients at risk for adverse cardiac events and poor treatment response.