Global longitudinal strain as a prognostic marker in cardiac resynchronisation therapy: A systematic review. (August 2021)

• Record Type: Journal Article
• Authors: Appadurai, Vinesh; D'Elia, Nicholas; Mew, Thomas; Tomlinson, Stephen; Chan, Jonathan; Hamilton-Craig, Christian; Scalia, Gregory M.
• Is Part Of: IJC heart & vasculature. Volume 35(2021)
• Publication Date: 2021-08
• Subjects: Global longitudinal strain -- Cardiac resynchronisation therapy -- Speckle tracking echocardiography; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular system -- Pathophysiology -- Periodicals; 616.1005
• DOI: 10.1016/j.ijcha.2021.100849
• Languages: English
• ISSNs: 2352-9067

Abstract

Highlights: Left ventricular global longitudinal strain (LV GLS) is a sensitive parameter that correlates with myocardial scar burden and fibrosis with potential value in CRT candidates. First systematic review evaluating the existing evidence for the prognostic value of LV GLS in patients undergoing CRT implantation. Despite significantly abnormal baseline GLS at CRT implantation, there is still a significant association between incrementally worse LV GLS at CRT implantation and prognostic outcomes on long-term follow-up. Abstract: Purpose: Cardiac resynchronisation therapy (CRT) has proven mortality benefits for heart failure patients with moderate to severe systolic left ventricular dysfunction and evidence of a left bundle branch block. Determining responders to this therapy can be difficult due to the presence of myocardial fibrosis and scar. Left ventricular global longitudinal strain (LV GLS) is a robust and sensitive measure of myocardial function and fibrosis that has significant prognostic value for a plethora of cardiac pathologies. Our aim was to perform a systematic review of the value of LV GLS for predicting outcomes in patients undergoing CRT. Methods: A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) protocol for reporting on systematic reviews and meta-analyses. An electronic search of all English, adult publications in EMBASE, MEDLINE/PubMed and the Cochrane Database of Systematic reviews was undertaken. Results: The search yielded, 9 studies that included 3, 981 patients with symptomatic heart failure, undergoing CRT implantation with LV GLS utilised as a predictor of all-cause mortality, cardiovascular death, rehospitalisation, LVAD implantation/ heart transplantation or left ventricular reverse remodelling. Significant heterogeneity was observed in study outcome measures, included populations, LV-GLS cut-offs and follow-up definitions, resulting in the inability to reliably conduct a meta-analyses. Overall, pre-CRT LV GLS was found to be a predictor of outcome post CRT insertion. Conclusions: In conclusion, all studies implied that incrementally abnormal baseline LV GLS pre-CRT implantation was associated with a long term poorer outcome.