June 7, 2022PLoS ONEOpen Access

Evaluation of subclinical ventricular systolic dysfunction assessed using global longitudinal strain in liver cirrhosis: A systematic review, meta-analysis, and meta-regression

View Full Paper

Ask AI

Bookmark

Why the study?

GLS can identify subclinical myocardial dysfunction in cirrhosis, but evidence evaluating differences in GLS values between patients with and without cirrhosis required systematic synthesis.

Does liver cirrhosis reduce global longitudinal strain compared to patients without cirrhosis?

Structured PICO

Does liver cirrhosis reduce global longitudinal strain compared to patients without cirrhosis?

Population

1,738 adults (aged >18 and ≤80 years) pooled from 20 observational studies (6 cross-sectional, 6 case-control, 8 prospective cohort) across 12 countries, comparing patients with liver cirrhosis to those without cirrhosis. Excluded patients with reduced/mid-range EF heart failure.

Intervention

Liver cirrhosis (disease exposure)

Comparator

Patients without liver cirrhosis (controls)

Outcome

Difference in left ventricular (LV) and right ventricular (RV) global longitudinal strain (GLS) valuessurrogate

Liver cirrhosis is associated with subclinical left and right ventricular systolic dysfunction, as evidenced by significantly reduced global longitudinal strain compared to non-cirrhotic controls.

Implication

May prompt GLS evaluation for subclinical biventricular dysfunction in cirrhosis; leaves open prognostic impact and management implications.

Abstract

Global longitudinal strain (GLS) can identify subclinical myocardial dysfunction in patients with cirrhosis. This systematic review aims to provide evidence of a possible difference in GLS values between patients with cirrhosis and patients without cirrhosis. Studies from inception to August 11, 2021, were screened and included based on the inclusion criteria. The Newcastle Ottawa Scale was used to assess the quality of nonrandomized studies. Meta-analyses were conducted with subsequent sensitivity and subgroup analyses according to age, sex, cirrhosis etiology, and severity. Publication bias was evaluated using Begg's funnel plot, Egger's test, and rank correlation test with subsequent trim-and-fill analysis. The systematic database search yielded 20 eligible studies. Random effect showed a significant reduction of left ventricular (LV) GLS (MD:-1.43;95%; 95%CI,-2.79 to -0.07; p = 0.04; I2 = 95% p<0.00001) and right ventricular (RV) GLS (MD:-1.95; 95%CI,-3.86 to -0.05, p = 0.04; I2 = 90%, p<0.00001) in the group with cirrhosis. A sensitivity test on subgroup analysis based on the study design showed a -1.78% lower LV-GLS in the group with cirrhosis (I2 = 70%, p = 0.0003). Meta-regression analysis showed that the severity of cirrhosis was significantly related to GLS reduction. This research received no specific grants from any funding agency in the public, commercial, or not-for-profit sectors. The study protocol was registered at PROSPERO (CRD42020201630). We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement guidelines.