Left ventricular longitudinal systolic function analysed by 2D speckle-tracking echocardiography in heart failure with preserved ejection fraction: a meta-analysis

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.

Keywords: echocardiography; heart failure; speckle-tracking; strain.

Figure 1

Search process. We searched in different databases (Medline, Embase and Cochrane) published studies until 15 June 2017 that analysed the global longitudinal systolic function of the left ventricular (LV) (global longitudinal systolic strain (GLS)) using two-dimensional speckle-tracking echocardiography in patients with heart failure with preserved ejection fraction. We searched the following Medical Subject Heading terms: ‘heart failure’, ‘echocardiography’ and ‘strain’. HF, indicates heart failure; LVEF, indicates left ventricular ejection fraction.

Figure 2

LV global longitudinal systolic strain (GLS) in patients with heart failure with preserved ejection fraction (HFpEF) vs asymptomatic patients. GLS is shown in absolute values.

Figure 3

LV global longitudinal systolic strain (GLS) in patients with heart failure with preserved ejection fraction (HFpEF) vs healthy subjects. GLS is shown in absolute values.

Figure 4

Left ventricular ejection fraction (LVEF) in patients with heart failure with preserved ejection fraction (HFpEF) vs asymptomatic and healthy controls. The study by Shah et al was not included in this analysis because the value of LVEF in the control group was not reported.

Figure 5

LV global longitudinal systolic strain (GLS) in patients with heart failure with preserved ejection fraction (HFpEF) vs asymptomatic and healthy controls in studies including ≥ 100 patients with HFpEF. GLS is shown in absolute values.

Figure 6

LV global longitudinal systolic strain (GLS) in patients with heart failure with preserved ejection fraction (HFpEF) vs asymptomatic and healthy controls in studies including < 100 patients with HFpEF. GLS is shown in absolute values.

Figure 7

LV global longitudinal systolic strain (GLS) in patients with heart failure with preserved ejection fraction (HFpEF) without atrial fibrillation vs asymptomatic and healthy controls. GLS is shown in absolute values.