Global longitudinal strain as a prognostic marker in cardiac resynchronisation therapy: A systematic review

Vinesh Appadurai; Nicholas D'Elia; Thomas Mew; Stephen Tomlinson; Jonathan Chan; Christian Hamilton-Craig; Gregory M Scalia

doi:10.1016/j.ijcha.2021.100849

Global longitudinal strain as a prognostic marker in cardiac resynchronisation therapy: A systematic review

Int J Cardiol Heart Vasc. 2021 Jul 31:35:100849. doi: 10.1016/j.ijcha.2021.100849. eCollection 2021 Aug.

Authors

Vinesh Appadurai^{1

2}, Nicholas D'Elia^{3

4}, Thomas Mew^{1

2}, Stephen Tomlinson^{1

2}, Jonathan Chan^{1

5}, Christian Hamilton-Craig^{1

2

5}, Gregory M Scalia^{1

2}

Affiliations

¹ Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia.
² School of Medicine, The University of Queensland, St Lucia, Australia.
³ The Alfred Hospital, Melbourne, Victoria, Australia.
⁴ Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia.
⁵ School of Medicine, Griffith University, Gold Coast, Australia.

Abstract

Purpose: Cardiac resynchronisation therapy (CRT) has proven mortality benefits for heart failure patients with moderate to severe systolic left ventricular dysfunction and evidence of a left bundle branch block. Determining responders to this therapy can be difficult due to the presence of myocardial fibrosis and scar. Left ventricular global longitudinal strain (LV GLS) is a robust and sensitive measure of myocardial function and fibrosis that has significant prognostic value for a plethora of cardiac pathologies. Our aim was to perform a systematic review of the value of LV GLS for predicting outcomes in patients undergoing CRT.

Methods: A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) protocol for reporting on systematic reviews and meta-analyses. An electronic search of all English, adult publications in EMBASE, MEDLINE/PubMed and the Cochrane Database of Systematic reviews was undertaken.

Results: The search yielded, 9 studies that included 3,981 patients with symptomatic heart failure, undergoing CRT implantation with LV GLS utilised as a predictor of all-cause mortality, cardiovascular death, rehospitalisation, LVAD implantation/ heart transplantation or left ventricular reverse remodelling. Significant heterogeneity was observed in study outcome measures, included populations, LV-GLS cut-offs and follow-up definitions, resulting in the inability to reliably conduct a meta-analyses. Overall, pre-CRT LV GLS was found to be a predictor of outcome post CRT insertion.

Conclusions: In conclusion, all studies implied that incrementally abnormal baseline LV GLS pre-CRT implantation was associated with a long term poorer outcome.

Keywords: Cardiac resynchronisation therapy; Global longitudinal strain; Speckle tracking echocardiography.