Speckle Tracking Echocardiography Can Predict Subclinical Myocardial Involvement in Patients with Sarcoidosis: A Meta-Analysis

Abstract

Background This meta-analysis aims to evaluate the utility of speckle tracking echocardiography (STE) as a tool to evaluate for cardiac sarcoidosis (CS) early in its course. Electrocardiography and echocardiography have limited sensitivity in this role, while advanced imaging modalities such as cardiac magnetic resonance (CMR) and 18F-Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) are limited by cost and availability. Methods We compiled English language articles that reported left ventricular global longitudinal strain (LVGLS) or global circumferential strain (GCS) in patients with confirmed extra-cardiac sarcoidosis versus healthy controls. Studies that exclusively included patients with probable or definite CS were excluded. Continuous data were pooled as a standard mean difference (SMD) between the sarcoidosis group and controls. A random effect model was adopted in all analyses. Heterogeneity was assessed using Q and I2 statistics. Results Nine studies with 967 patients were included in our analysis. LVGLS was significantly lower in the extra-cardiac sarcoidosis group as compared to controls, SMD -3.98, 95% confidence interval (CI): -5.32, -2.64, p< 0.001, also was significantly lower in patients who suffered Major Cardiac Events(MCE), -3.89, 95% CI -6.14, -1.64, p< 0.001 . GCS was significantly lower in the extra-cardiac sarcoidosis group as compared to controls, SMD: -3.33, 95% CI -4.71, -1.95, p< 0.001 Conclusion LVGLS and GCS were significantly lower in extra-cardiac sarcoidosis patients despite not exhibiting any cardiac symptoms. LVGLS correlates with MCEs in CS. Further studies are required to investigate the role of STE in the early screening of CS.

Myocardial findings evaluated by echocardiography in cardiac sarcoidosis: A report of seven cases

“…TTE has been thought to have low sensitivity and specificity in diagnosing CS when compared with CMR and PET‐CT, 16 although TTE has advantage in terms of availability, portability, and cost‐effectiveness, but still provides valuable clues for the diagnosis 15 . The advent of STE allows more precise evaluation of the myocardial characteristics and function in many types of cardiomyopathies.…”

“…Newer echocardiographic parameters on myocardial mechanics such as strain may be useful for detecting dysfunctional myocardium even in the absence of apparent basal thinning. Studies demonstrated that among extra‐cardiac CS patients, global longitudinal strain (GLS) was reduced compared with normal controls, 14,15 with the reduction of strain prominent over the basal segments 14 …”

Prognostic impact of atrial function in cardiac sarcoidosis using two-dimensional speckle-tracking echocardiography

“…Fread et al reported that LAGLS of ≤ 31.2% was associated with worse outcomes in patients with heart failure with preserved ejection fraction 27 . Regarding GLS in CS, a few studies reported the usefulness of 2D-STE for assessing LV function to predict the prognosis in sarcoidosis [28][29][30] . Cristina et al reported that reduced LVGLS and RVGLS were correlated with adverse cardiac events 30 .…”

The Importance of Multimodality Imaging in the Diagnosis and Management of Patients with Infiltrative Cardiomyopathies: An Update

“…In addition, a meta-analysis performed by Barssoum K. et al, comprising 9 studies and 967 subjects, proved that both LV GLS and global circumferential strain are substantially lower in extracardiac sarcoidosis subjects and no clinical evidence of cardiac involvement and that the degree of LV GLS impairment correlates with the occurrence of major cardiac events [ 62 ]. Additionally, the circumferential strain has proved to be an indicator of fibrosis burden in subjects with extracardiac sarcoidosis.…”