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), comparing sarcoidosis group with healthy controls. A random-effect model was adopted in all analyses. Heterogeneity was assessed using Q and I2 statistics. Results: Nine studies were included in our final analysis with an aggregate of 967 patients. LVGLS was significantly lower in the extra-cardiac sarcoidosis group as compared with controls, SMD −3.98, 95% confidence interval (CI): −5.32, −2.64, P < .001, also was significantly lower in patients who suffered major cardiac events (MCE), −3.89, 95% CI −6.14, −1.64, P < .001. GCS was significantly lower in the extra-cardiac sarcoidosis group as compared with controls, SMD: −3.33, 95% CI −4.71, −1.95, P < .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.

Strain Echocardiography Is a Promising Tool for the Prognostic Assessment of Sarcoidosis

“…The sarcoidosis status was classified as worsened if a therapeutic step-up (increase in or start of steroids and/or immunosuppressive drugs) was needed according to the advice of the respiratory physician and/or if evidence of organ damage due to sarcoidosis was identified through a clinical, radiological and laboratory assessment during the follow-up according the latest guidelines [ 12 , 13 , 14 , 15 , 16 , 17 ].…”

“…However, as a comprehensive guideline, the ATS document focused on “traditional” TTE and, in particular, with the left ventricular (LV) ejection fraction (EF) estimation and wall motion abnormalities related to coronary artery diseases. In the last decade, a new imaging semi-automatic technique of speckle tracking echocardiography (STE) has proven to be more sensitive in the early detection of myocardial damage and less operator-sensitive than traditional TTE [ 13 ]. Not surprisingly, many studies have demonstrated that STE is significantly better than TTE in the early detection of myocardial damage or sarcoid involvement and also in predicting cardiac events in the follow-up of sarcoidosis patients [ 13 , 14 , 15 , 16 ].…”

“…In the last decade, a new imaging semi-automatic technique of speckle tracking echocardiography (STE) has proven to be more sensitive in the early detection of myocardial damage and less operator-sensitive than traditional TTE [ 13 ]. Not surprisingly, many studies have demonstrated that STE is significantly better than TTE in the early detection of myocardial damage or sarcoid involvement and also in predicting cardiac events in the follow-up of sarcoidosis patients [ 13 , 14 , 15 , 16 ]. However, scarce data are available on the potential utility of STE in the prognostic assessment of sarcoidosis and the prediction of a sarcoidosis relapse.…”

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.…”

Current State and Future Directions of Multimodality Imaging in Cardiac Sarcoidosis

“…Additionally, multiple observational studies have demonstrated that reductions in GLS may be identified by STE in patients with sarcoidosis without known CS or apparent LV dysfunction, suggestive of early subclinical myocardial dysfunction (24)(25)(26)(27). A recent meta-analysis of these studies found that LVGLS was significantly impaired in patients with extracardiac sarcoidosis and normal LV function compared with controls, and that among patients with sarcoidosis, LVGLS was significantly reduced in patients who experienced major cardiac events (28). These studies suggest a potential role for STE as a more sensitive screening tool than traditional echocardiography alone to identify patients with extracardiac sarcoidosis at increased risk for cardiac involvement.…”