Cardiovascular assessment in cirrhosis: is global longitudinal strain altered in cirrhosis? A meta‐analysis and review

Background and aims Evaluation of cardiac function and determining the potential risk of cardiac complications with liver transplantation has been both a topic of contention and discussion. Global longitudinal strain (GLS) imaging has been used to identify subclinical myocardial dysfunction in other pathologies; however, its use in the cirrhosis population is unclear. A meta‐analysis was performed to assess GLS values in patients with cirrhosis compared to healthy controls. Methods A literature search was conducted for studies that evaluated GLS in patients with cirrhosis compared to healthy controls published until September 18, 2020. Primary outcomes looked at differences in GLS values between these populations. Results Thirteen total studies were included in the meta‐analysis. Overall, 802 patients with cirrhosis and 540 healthy controls were included in the analysis. The GLS values were numerically more negative in the healthy control group versus patients with cirrhosis (raw mean difference ‐2.5%, 95% CI ‐3 to ‐1.9, P = < .001), I2 = 81%. Conclusion GLS can be used as an early marker of subclinical myocardial dysfunction. We noted a difference in GLS values in patients with cirrhosis compared to healthy control subjects in this meta‐analysis. Other traditional systolic and diastolic echocardiographic parameters were not found to be significantly different between patients with cirrhosis versus healthy controls. This may indicate utilization of GLS when screening for cardiac dysfunction prior to liver transplantation.