Left ventricular assessment using speckle-tracking echocardiography in Behçet's disease: a systematic review and meta-analysis

OBJECTIVES: Behçet's disease (BD) is a multisystem inflammatory disorder associated with increased cardiovascular morbidity. Conventional echocardiography often fails to detect early myocardial involvement. Speckle tracking echocardiography (STE) allows sensitive assessment of left ventricular (LV) myocardial deformation, particularly global longitudinal strain (GLS). The aim of this study is to systematically evaluate LV systolic function assessed by STE in BD patients and to compare GLS differences with healthy controls. METHODS: PubMed, Scopus and Web of Science databases were searched for studies assessing LV strain by STE in BD. Studies using two- or four-dimensional STE were included. Pooled standardised mean differences (SMD) in LV GLS between BD patients and controls were calculated using random-effects models. Heterogeneity was assessed using I2 and Cochrane Q test and was further explored using Baujat plot and leave-one-out analysis. PROSPERO registry number: CRD420251251109. RESULTS: Eight studies including 373 BD patients and 402 controls were included. LV GLS was not significantly reduced in BD compared to controls (SMD -0.59; 95% CI -1.21 to 0.04; p=0.06). Subgroup analyses showed that GLS impairment was more pronounced in patients with non-active disease (SMD -0.9; 95% CI -1.71 to -0.08), while no significant difference was observed in patients with no cardiovascular risk factors (p=0.20). CONCLUSIONS: BD patients do not exhibit consistent subclinical LV systolic dysfunction in strain echocardiography. Further studies are required to optimise the use of STE in this population.