Usefulness of speckle-tracking echocardiography for early detection in children with Duchenne muscular dystrophy: a meta-analysis and trial sequential analysis

Abstract

Background Duchenne muscular dystrophy (DMD) is the most common form of inherited muscle disease in children. The incidence of cardiomyopathy induced by DMD increases with age. Left ventricular ejection fraction usually fails to reflect the subclinical left ventricular dysfunction. Several studies have assessed this dysfunction using myocardial strain measured by speckle-tracking echocardiography (STE). However, the results were inconsistent and incomplete. Methods Several databases were searched from their inception to February 5, 2020. The summarized weighted mean difference (WMD) with 95% confidence intervals (CIs) were estimated for myocardial strain between DMD and healthy controls and a meta-analysis was conducted. Trial sequential analysis estimated whether the resulting evidence was sufficient. Results Eight studies with a total of 269 DMD children and 299 healthy participants were included. STE revealed that global longitudinal strain (GLS), global circumferential strain, average longitudinal strain (measured by two-dimensional STE at the apical four-chamber view), and average circumferential strain (measured by two-dimensional STE at the papillary muscle short-axis level) decreased (WMD = 4.17, 95% CI: 3.03–5.32; WMD = 3.98, 95% CI: 0.29–7.68; WMD = 4.18, 95% CI: 2.75–5.62; and WMD = 4.90, 95% CI: 2.38–7.43, respectively; all P < 0.05) compared with the controls and global radial strain was unchanged in the DMD group (WMD = − 4.33, 95% CI: − 9.53–0.87, P = 0.103). Trial sequential analysis indicated that available GLS samples were sufficient and confirmed that adequate evidence was accumulated. The credibility of other myocardial strains was questioned due to insufficiently involved studies. Conclusion GLS can be useful for early detection of left ventricle myocardial dysfunction in children with DMD.

Cardiac MRI and Echocardiography for Early Diagnosis of Cardiomyopathy Among Boys With Duchenne Muscular Dystrophy: A Cross-Sectional Study

“…(34,35). Subsequently a meta-analysis by Song et al concluded that global strain pattern is the best technique for early detection of myocardial strain (36). Global strain was reduced in 4 (15%) subjects in our cohort.…”

“…Taqatqa et al reported a reduced global circumferential strain, and Cho et al reported a reduced global longitudinal strain in boys with DMD ( 34 , 35 ). Subsequently a meta-analysis by Song et al concluded that global strain pattern is the best technique for early detection of myocardial strain ( 36 ). Global strain was reduced in 4 (15%) subjects in our cohort.…”

Global longitudinal strain detects subtle left ventricular systolic dysfunction in Duchenne muscular dystrophy patients and carriers

“…We observed that despite normal mean LV EF in DMD patients and carriers, the mean GLS was significantly lower in DMD patients and female carriers that indicated subclinical myocardial affection. This is supported by many studies that found that the application of myocardial strain imaging in DMD patients was characterized by decreased peak systolic strain, despite normal standard echocardiographic findings [ 11 – 14 ]. In mutation carriers, CMR revealed a pattern of fibrosis similar to that observed in DMD, even in the absence of overt muscular disease [ 15 ].…”

CardiOvascular examination in awake Orangutans (Pongo pygmaeus pygmaeus): Low-stress Echocardiography including Speckle Tracking imaging (the COOLEST method)

“…This is of particular interest as myocardial diseases, mainly including fibrosing cardiomyopathy and myocarditis, represent the most common orangutan heart diseases [1,[4][5][6]. The ability of STI to early detect systolic myocardial dysfunction has been demonstrated in human patients with various subclinical myocardial diseases characterized by normal conventional echocardiographic parameters (including LV diameters, fractional shortening, and ejection fraction) [17,18]. We can therefore hypothesize that STI combined with spectral Doppler parameters of diastolic function could be useful for the early detection of myocardial diseases in captive BO.…”