Speckle tracking echocardiography and β-thalassemia major. A systematic review

Abstract

Heart disease is among the primary causes of morbidity and mortality in β-thalassemia major (β-TM). Conventional echocardiography has failed to identify myocardial dysfunction at an early stage among these patients, thus speckle tracking echocardiography (STE) has been lately used. The objectives of this review were to 1) identify all published studies having evaluated myocardial strain among β-TM patients, 2) gather their results, 3) compare their findings and 4) propose recommendations based on these data. Literature search was conducted in PubMed, SCOPUS and Cohrane Library. Data regarding left ventricular global longitudinal (LV-GLS), circumferential (LV-GCS) and radial strain (LV-GRS), right ventricular longitudinal strain (RV-GLS), left and right atrial strain were extracted. Thirty-five studies (34 original articles and 1 meta-analysis) have met the inclusion criteria. LV-GLS has been reported being worse in patients compared to controls in 13 of 21 studies, LV-GCS in 7 of 11 studies, LV-GRS in 6 of 7 studies, RV-GLS in 2 of 3 studies and left atrial strain in all case–control studies. Myocardial iron overload (MIO) patient subgroups had worse LV-GLS in 6 of 15 studies, LV-GCS in 2 of 7 studies and LV-GRS in none of 7 studies. A small number of studies suggest left atrial strain correlation with electrical atrial ectopy and atrial fibrillation. It is suggested that STE should be applied supplementary to conventional echocardiography for early identification of myocardial dysfunction among β-TM patients. Potential myocardial strain utilities could be screening for myocardial iron overload, left ventricular diastolic dysfunction and atrial fibrillation.

Role of Myocardial Strain Analysis by 2-Dimensional Speckle Tracking Echocardiography in Assessment of Severity of Coronary Artery Stenosis in Coronary Artery Disease Patients

“…There was incremental significant decrease in GLS with increasing number of coronary vessels involved (13) . The optimal GLS diagnostic cutoff value varies significantly among previous studies could be explained by GLS may depend on the clinical characteristics of patients, the effect of diastolic function and their hemodynamic parameters (i.e., blood pressure) during image acquisition, by using different equipment, different design, vendor-dependent 2D-STE software and operator skills (16) . Another data has indicated that GLS is more dependent on the 2D-STE software used, rather than ultrasound equipment used to acquire images, which makes the use of vendor-independent software particularly attractive to standardize GLS for widespread use.…”

“…Another data has indicated that GLS is more dependent on the 2D-STE software used, rather than ultrasound equipment used to acquire images, which makes the use of vendor-independent software particularly attractive to standardize GLS for widespread use. The possibility of using a fixed diagnostic GLS cutoff value to diagnose obstructive CAD, independent of the ultrasound equipment used for images acquisition, would be required to increase the clinical usefulness of strain imaging (16) .…”