Association of Global Longitudinal Strain with the Development of Adverse Left Ventricular Remodelling: A Systematic Review and Meta-Analysis.

Background: Global longitudinal strain (GLS) is associated with major adverse cardiovascular outcomes independent of LVEF. However, the association of GLS with the development of adverse left ventricular remodelling (LVR) is not well established. Aim(s): To study the relationship between abnormal GLS (>-16%) and LVR in patients with normal resting LVEF. Method(s): Embase, Medline and Cochrane databases were systematically searched to identify studies utilising GLS and LVEF in predicting LVR. The primary outcome was mean difference in GLS in patients who develop LVR compared to those who do not develop LVR at >=3 months. The reviewers followed PRISMA protocol. Result(s): Eleven studies were included in the final quantitative analysis of 700 patients (mean age 59.5 +/- 11.9, Male = 68%). When patients who developed LVR were compared with those without LVR, mean baseline LVEF was: 56.1% (95%CI = 54.9-57.3, P < 0.0001) vs. 61.6% (60.6-62.6, P < 0.0001) and mean baseline GLS was: -15.7% (-16.5 to -15.1, P < 0.0001) vs. -19.5% (-20 to -18.9, P < 0.0001) whereas, mean differences of baseline GLS and EF in LVR group were statistically significant: 3.8% (3.0-4.6, P < 0.0001) and -5.5% (-7.0 to -3.9, P < 0.0001) respectively. When baseline and follow-up LVEF and GLS are compared in LVR group, mean LVEF difference was 3.62 (2.06 to 5.18, I2 = 38%, P < 0.0001) and mean GLS difference was -2.17 (-3.21 to -1.13, I2 = 71%, P < 0.0001) (Fig. 1 ) whilst in those without LVR, mean LVEF and GLS difference were 2.71 (-4.92 to -0.50, I2 = 75%, P = 0.02) and 0.64 (-0.74 to 2.03, I2 = 84%, P = 0.36). Conclusion(s): Abnormal GLS at baseline and further worsening at follow-up is associated with the development of adverse LVR. Therefore, patients with abnormal resting GLS may benefit from closer surveillance and earlier therapy.Copyright © 2019
P. Thein, MonashHeart and Monash Cardiovascular Research Centre, Monash Health and Monash University, Melbourne, Australia
CONFERENCE ABSTRACT