Author + information
- Received May 21, 2018
- Revision received July 13, 2018
- Accepted July 19, 2018
- Published online October 7, 2019.
- Albree Tower-Rader, MDa,∗,
- Divyanshu Mohananey, MDa,∗,
- Andrew To, MDa,b,
- Harry M. Lever, MDa,
- Zoran B. Popovic, MD, PhDa and
- Milind Y. Desai, MDa,∗ ()
- aHypertrophic Cardiomyopathy Center, Cleveland Clinic, Cleveland, Ohio
- bNorthshore Hospital, Auckland, New Zealand
- ↵∗Address for correspondence:
Dr. Milind Y. Desai, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, Ohio 44195.
Objectives The association of left ventricular global longitudinal strain (LV-GLS) with clinical outcomes in patients with hypertrophic cardiomyopathy (HCM) has been examined in multiple studies. The authors conducted a systematic review aimed at summarizing and critically appraising the current evidence.
Background HCM is a common genetic cardiovascular disease with an estimated prevalence of 1 in 500 patients. LV-GLS derived from speckle tracking echocardiography is a sensitive noninvasive method of assessing regional left ventricular function. Several studies have suggested association of abnormal LV-GLS with outcomes in HCM patients.
Methods A computerized literature search of all English language publications in the PubMed and EMBASE databases was made looking at all randomized and nonrandomized studies conducted on patients with HCM where association of LV-GLS with clinical outcomes was studied. We then manually searched the reference lists of included articles. The Preferred Reporting Items for Systematic reviews and Meta-Analyses statement (PRISMA) of reporting systematic reviews was used.
Results Our search yielded a total of 14 observational studies published between 2009 and 2017 with a total of 3,154 patients with HCM. Eleven of the 14 studies included a composite cardiac outcome which included mortality as their primary outcome of interest and 3 of the 14 studies looked at association of LV-GLS with ventricular arrhythmias and/or implantable cardiac defibrillator discharge. We noted wide variability in inclusion, methodology, follow-up, and consequently effect estimates, which was not conducive to performing a meta-analysis. However, despite the variation, all studies revealed a degree of association of abnormal LV-GLS with poor cardiac outcomes.
Conclusions Our systematic review of more than 3000 HCM patients suggests an association of abnormal LV-GLS with adverse composite cardiac outcomes and ventricular arrhythmias.
↵∗ Drs. Tower-Rader and Mohananey contributed equally to this work and are joint first authors.
Dr. Desai is supported by the Haslam Family Endowed Chair in Cardiovascular Medicine.
All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 21, 2018.
- Revision received July 13, 2018.
- Accepted July 19, 2018.
- 2019 American College of Cardiology Foundation
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