Speckle tracking echocardiography in patients with systemic sclerosis: a meta-analysis

Abstract

Background Myocardial dysfunction is well established in systemic sclerosis (SSc). The utility of standard echocardiography is limited to detect the onset of myocardial dysfunction. Speckle tracking echocardiography (STE) and strain imaging has emerged as a useful technique to quantify left ventricle hemodynamics and myocardial function in early stages of myocardial dysfunction. We aimed to systematically analyze the existing literature on the application of STE and strain analysis in identifying SSc associated myocardial dysfunction Methods PubMed, Cochrane, and Google Scholar were queried for studies from the inception of the databases to 2022. Case control studies that used 2D STE for assessment of strain in SSc patients and controls, were included for the analysis. PRISMA guidelines were followed for selections of studies. Two independent reviewers extracted data. Analysis was done using Cochrane Review Manager 5.0. Results Total of 19 studies were included in the analysis that compared strain analysis in SSc patient's vs healthy controls. Of the 16 studies that reported left ventricular (LV) global longitudinal strain, we found significantly lower LV global longitudinal strain in SSc patients (mean difference 1.92; 95% CI 0.98–2.87). Six studies reported LV circumferential strain which was noted to be lower in SSc patients compared to healthy controls (mean difference 3.55; 95% CI 1.60–5.51). Five studies reported LV global radial strain with a similar decrease in radial strain among SSc patients compared to controls (mean difference 4.39; 95% CI −6.95 to −1.83). 10 studies reported right ventricular longitudinal strain with a decrease in longitudinal strain in SSc patient's vs controls (mean difference 2.57; 95% CI 2.03–3.12). Conclusions SSc patients have lower strain values compared to controls, which is suggestive of an impaired myocardial function in left and right ventricle. Strain analysis by STE could help with early detection of myocardial dysfunction. Funding Acknowledgement Type of funding sources: None.