Speckle tracking echocardiography in the assessment of left ventricular systolic function in patients with autoimmune disorders: review and meta-analysis

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Autoimmune disorders, namely Systemic lupus erythematosus (SLE) and Systemic Sclerosis (SSc) are characterized with high incidence of cardiovascular morbidity and mortality. Autopsy data shows high prevalence of myocardial involvement in these patients, however left ventricular systolic dysfunction is diagnosed in few of them, due to low sensitivity of current diagnostic tools. Purpose The present study aimed to perform an extensive systemic review and meta-analysis of the current case-control studies based on the assessment of the left ventricular systolic function with advanced echocardiographic methods such as speckle tracking echocardiography (STE) derived left ventricular global longitudinal strain (LV GLS), which has been proven to be a more sensitive tool for the detection of subtle myocardial changes in different entities. Methods The objectives, literature search strategies, inclusion and exclusion criteria, outcome measurements, and methods of statistical analysis were analyzed according to an established protocol of the Cochrane collaboration steps and meta-analysis of observational studies in epidemiology recommendations (MOOSE). Results A total of 420 papers were collected according to our searching criteria, of those 9 studies including 462 SLE patients and 356 controls and also 8 studies including 660 SSc patients and 370 controls with evaluated LV GLS were selected. We found, that overall patients with SLE exhibited lower levels of LV GLS as compared to controls: [Std. Mean Difference, (95% CI) −1.35 (−1.86 to −0.83); p<0.00001]. From selected 9 studies, one study had performed three-dimensional (3D) STE derived LV GLS assessment, including 34 SLE patients and also 34 controls. Subgroup analysis showed that 3D STE derived LV GLS was significantly lower in SLE patients as compared to healthy controls [Std. Mean Difference, (95% CI) −1.17 (−1.69 to −0.65); p<0.00001]. LV GLS was significantly lower in SSc patients in every reported study as compared to controls: [Std. Mean Difference, (95% CI) −2.26 (−2.88 to −1.64); p<0.00001]. Moreover, some studies showed significant association between deteriorated LV GLS and cardiovascular events in SLE and SSc patients. Conclusions LV systolic function as measured by LV GLS is significantly affected in SLE and SSc patients. Meta-analysis suggests that in autoimmune disorders STE derived LV GLS assessment potentially represents a new tool in the detection of subtle myocardial changes even at subclinical stage of the heart failure and therefore may improve risk-stratification in patients with SLE and SSc.