Left ventricular global longitudinal strain is the best echocardiographic parameter to diagnose subclinical myocardial dysfunction in populations with autoimmune diseases: Results from a systematic review and Meta Analysis

Abstract

BACKGROUND: Patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) frequently develop myocardial dysfunction as a result of systemic inflammation. Early discrimination of myocardial dysfunction on transthoracic echocardiography (TTE) can identify higher risk subgroups. The aim of this study was to determine TTE indices that can reliably differentiate higher risk autoimmune populations from healthy controls. METHODS: A systematic search of medical databases was performed using PRISMA principles to identify all relevant studies in adult patients with SLE and RA versus controls (2000-2022; English only). Data for a range of TTE parameters was meta-analyzed using a random-effects model for overall effect size, and assessed through standardized mean difference (SMD). RESULTS: 35 studies including a total of 2319 SLE patients and 40 studies including a total of 3080 RA patients were analyzed. Left ventricular (LV) global longitudinal strain (GLS), compared to other parameters, demonstrated the highest overall effect size in both, the SLE population (SMD 1.02; 95% CI: 0.74-1.30, p<0.01) and RA population (SMD 1.41; 95% CI: 0.69-2.12, p<0.01) when compared to controls. See Table. CONCLUSION: In populations with SLE and RA, LV-GLS was the strongest discriminator from controls, thereby the most best tool in identifying early pathological myocardial substrates. Routine LV-GLS may allow for earlier identification and targeted therapy in these higher risk populations.