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INTRODUCTION: During the last decade, a small number of studies have used feature tracking (FT) cardiovascular magnetic resonance imaging (CMR) and speckle tracking echocardiography (STE) to investigate the effect of pectus excavatum (PE) on biventricular mechanics. The present systematic review and meta-analysis has been primarily designed to summarize the main findings of these studies and to examine the overall influence of PE on both left ventricular (LV)- and right ventricular (RV)-global longitudinal strain (GLS). EVIDENCE ACQUISITION: All imaging studies assessing conventional indices of biventricular size and function and myocardial strain parameters in PE individuals vs.. healthy controls, selected from PubMed and EMBASE databases, were included. The risk of bias was evaluated by using the National Institutes of Health (NIH) Quality Assessment of Case-Control Studies. Continuous data (LV-GLS and RV-GLS) were pooled as a standardized mean difference (SMD) comparing PE group with healthy controls. The overall SMDs of LV-GLS and RV-GLS were calculated using the random-effect model. EVIDENCE SYNTHESIS: The full-text of 7 studies with a total of 374 PE individuals and 141 healthy controls were analyzed. Both average LV-GLS (-17.1±3.5% vs. -18.9±3.0%, P<0.001) and RV-GLS (-17.9±5.2% vs. -20.9±3.7%, P<0.001) were significantly lower in PE patients than controls. Subtotal SMD was small and not statistically significant for CMR studies assessing LV-GLS (-0.23, 95%CI -0.92,0.47, P=0.52) and RV-GLS (-0.33, 95%CI -0.94,0.28, P=0.28), whereas subtotal SMD was large and statistically significant for echocardiographic studies measuring LV-GLS (-1.46, 95%CI -2.55,-0.38, P=0.008) and RV-GLS (-1.71, 95%CI -2.68,-0.74, P=0.001). The overall effect of PE was statistically significant on RV-GLS (SMD -0.72, 95%CI -1.24,-0.21, P=0.006), but not on LV-GLS (SMD -0.58, 95%CI -1.17,-0.00, P=0.05). Substantial heterogeneity was found for the studies assessing LV-GLS (I2=88.2%) and RV-GLS (I2=86.9%). Egger's test gave a P-value of 0.64 for LV-GLS and 0.47 for RV-GLS assessment, indicating no publication bias. On meta-regression analysis, none of the moderators was significantly associated with effect modification for both LV-GLS and RV-GLS (all P<0.05). CONCLUSIONS: The influence of PE on RV mechanics is greater than on LV mechanics. STE and FT-CMR may detect subtle impairment in biventricular mechanics in PE individuals. The attenuation of myocardial strain indices revealed by STE may be enhanced by methodological issues.
RESUMEN
BACKGROUND AND AIM: During the last decade, a small number of studies have used speckle tracking echocardiography (STE) to investigate sarcoidosis effect on left ventricular (LV) mechanics in patients without overt heart disease. The present systematic review and meta-analysis has been primarily designed to summarize the main findings of these studies and to examine the overall influence of sarcoidosis on LV-global longitudinal strain (GLS) and left ventricular ejection fraction (LVEF). METHODS: All echocardiographic studies assessing conventional echoDoppler parameters and myocardial strain indices in patients with extracardiac sarcoidosis (ECS) vs. healthy controls, selected from PubMed and EMBASE databases, were included. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment of Case-Control Studies. Continuous data (LV-GLS and LVEF) were pooled as a standardized mean difference (SMD) comparing sarcoidosis group with healthy controls. The overall SMDs of LV-GLS and LVEF were calculated using the random-effect model. RESULTS: The full-text of 13 studies with 785 ECS patients and 567 healthy controls were analyzed. Both average LVEF (60.5±6.6 vs 63.0±4.8%, P<0.001) and LV-GLS (-17.4±3.3 vs -21.0±2.7%, P<0.001) were significantly lower in ECS patients than controls. However, sarcoidosis showed a significantly larger effect on LV-GLS (SMD: -1.26, 95%CI -1.61,-0.91, P<0.001) rather than on LVEF (SMD: -0.51, 95%CI -0.83,-0.20, P=0.001). Substantial heterogeneity was found for the studies that assessed LV-GLS (I2=86.4%) and LVEF (I2=85.3%). Egger's test gave a P-value of 0.24 for LV-GLS and 0.32 for LVEF assessment, indicating no publication bias. On meta-regression analysis, none of the moderators was significantly associated with effect modification for both LV-GLS and LVEF (all P <0.05). CONCLUSIONS: In patients without overt heart disease, the effect of sarcoidosis on LV-GLS is significantly greater than on LVEF. STE analysis should be implemented in clinical practice for the early detection of myocardial involvement in ECS patients.
RESUMEN
PURPOSE: During the last decade, a number of echocardiographic studies have employed speckle tracking echocardiography (STE) for assessing myocardial deformation properties in individuals with mitral valve prolapse (MVP), reporting not univocal results. Accordingly, we performed a systematic review and meta-analysis to summarize the main findings of these studies and to examine the overall influence of MVP on left ventricular (LV) global longitudinal strain (GLS). METHODS: All echocardiographic studies assessing conventional echoDoppler parameters and myocardial strain indices in MVP individuals vs. controls without MVP, selected from PubMed and EMBASE databases, were included. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment of Case-Control Studies. Continuous data (LV-GLS) were pooled as a standardized mean difference (SMD) comparing MVP group with healthy controls. The overall SMD of LV-GLS was calculated using the random-effect model. RESULTS: The full-texts of 15 studies with 1088 individuals with MVP and 591 healthy controls were analyzed. Average LV-GLS magnitude was significantly, even though modestly, reduced in MVP individuals in comparison to controls (19.4 ± 3.4% vs. 21.1 ± 2.8%, P < 0.001). The overall effect of MVP on LV-GLS was small-to-medium (SMD - 0.54, 95%CI -0.76,-0.32, P < 0.001). Substantial heterogeneity was detected for the included studies, with an overall I2 statistic value of 75.9% (P < 0.001). Egger's test for a regression intercept gave a P-value of 0.58, indicating no publication bias. On meta-regression analysis, none of the moderators (the age, the percentage of females among MVP individuals, body mass index, heart rate and systolic blood pressure of MVP individuals, the degree of mitral regurgitation, the type of ultrasound machine employed for strain echocardiographic imaging and finally the beta blocker treatment) was significantly associated with effect modification (all P < 0.05). Regional strain analysis, performed by two-third of the studies, highlighted a more enhanced reduction in myocardial strain parameters at level of the LV basal infero-lateral segments in all directions (longitudinal, circumferential and radial), with apical sparing. CONCLUSIONS: The longitudinal strain impairment detected in MVP individuals is more regional than global, with peculiar involvement of the LV basal infero-lateral segments and relative apical sparing pattern.