Cardiac involvement assessment in systemic sclerosis using speckle tracking echocardiography: a systematic review and meta-analysis

Abstract

ObjectivesCardiac involvement in patients with systemic sclerosis (SSc) is associated with poor prognosis. Early detection of myocardial impairment is essential for treatment. The present study aimed to systematically review the value of detecting subclinical myocardial impairment in SSc patients using myocardial strain obtained from speckle tracking echocardiography (STE).DesignA systematic review and meta-analysis.Data sourcesThe PubMed, Embase and Cochrane library databases were searched in the period from the earliest available indexing date to 30 September 2022.Eligibility criteria for selecting studiesStudies evaluating myocardial function in SSc patients comparison with healthy controls based on myocardial strain data obtained from STE were included.Data extraction and synthesisVentricle and atrium data on myocardial strain were extracted to assessing the mean difference (MD).ResultsA total of 31 studies were included in the analysis. Left ventricular global longitudinal strain (MD: −2.31, 95% CI −2.85 to –1.76), left ventricular global circumferential strain (MD: −2.93, 95% CI −4.02 to –1.84) and left ventricular global radial strain (MD: −3.80, 95% CI −5.83 to –1.77) was significantly lower in SSc patients than in healthy controls. Right ventricular global wall strain (MD: −2.75, 95% CI −3.25 to –2.25) was also decreased in SSc patients. STE revealed significant differences in several atrial parameters including left atrial reservoir strain (MD: −6.72, 95% CI −10.09 to –3.34) and left atrial conduit strain (MD: −3.26, 95% CI −6.50 to –0.03), as well as right atrial reservoir strain (MD: −7.37, 95% CI −11.20 to –3.53) and right atrial conduit strain (MD: −5.44, 95% CI −9.15 to –1.73). There were no differences in left atrial contractile strain (MD: −1.51, 95% CI −5.34 to 2.33).ConclusionSSc patients have a lower strain than healthy controls for the majority of STE parameters, indicating the presence of an impaired myocardium involving both the ventricle and atrium.

Diagnosis and management of primary heart involvement in systemic sclerosis

“…Longitudinal strain was also used for RV analysis and identified the presence of reduced LV longitudinal strains, despite preserved RV strain in SSc patients without overt cardiac disease [45]. However, a recent meta-analysis revealed that SSc patients have a lower strain than healthy controls for the majority of STE parameters, supporting the presence of impaired myocardium involving both ventricles and atriums [46 ]. Tigen et al [47] reported that left atrial (LA) reservoir and conduit function was similar between the groups, but other studies have reported one or more decreased LA mechanics indices [48][49][50][51].…”

“…Although the STE results are promising for the early detection of SSc cardiac involvement, the meta-analyses of STE studies showed a significant heterogeneity. This can be explained in part by the differences in studied population, equipment and/or software used to detect myocardial strain [46 ▪ ].…”