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Updated: Aug 27, 2025
Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Prognostic value of global longitudinal strain in hypertrophic cardiomyopathy: A systematic review and meta-analysis
Ying Yang1, Dong Wu2, Hui Wang1
1Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China.
Insights
Impaired left ventricular global longitudinal strain (LVGLS) in hypertrophic cardiomyopathy (HCM) patients indicates a higher risk of major adverse cardiovascular events (MACE). This finding highlights LVGLS as a crucial prognostic marker in HCM.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Clinical Research
Background:
- Left ventricular global longitudinal strain (LVGLS) impairment is linked to adverse outcomes in hypertrophic cardiomyopathy (HCM).
- Understanding the prognostic value of LVGLS in HCM is critical for patient management.
Approach:
- A systematic meta-analysis was conducted using data from PubMed, Embase, Scopus, and Cochrane Library.
- Evaluated the association between LVGLS and major adverse cardiovascular events (MACE) in 2441 HCM patients across 13 studies.
- Calculated mean differences and pooled hazard ratios, addressing publication bias with trim-and-fill analysis.
Key Points:
- Lower absolute LVGLS values were observed in HCM patients experiencing MACE (MD = 2.74, p < .001).
- Impaired LVGLS demonstrated a significant association with MACE in both unadjusted (HR = 1.14, p < .05) and adjusted models (HR = 1.12, p < .05).
- Sensitivity analyses confirmed the stability of results, despite identified publication bias.
Conclusions:
- Impaired LVGLS is a significant predictor of poor prognosis in patients with hypertrophic cardiomyopathy.
- Echocardiography-derived LVGLS serves as a valuable tool for risk stratification in HCM.
- These findings support the integration of LVGLS assessment into routine clinical practice for HCM patients.
Background:
As previously reported, impairment of left ventricular global longitudinal strain (LVGLS) is associated with myocardial fibrosis, arrhythmias, and heart failure in hypertrophic cardiomyopathy (HCM) patients.
Hypothesis:
This study aimed to estimate the association between LVGLS measured by echocardiography and major adverse cardiovascular events (MACE) in patients with HCM.
Methods:
Pubmed, Embase, Scopus, and Cochrane Library databases were systematically searched for evaluating the difference of LVGLS between MACE and non-MACE and the relevance of LVGLS and MACE in HCM patients, mean difference (MD), and pooled hazard ratios (HR) with 95% confidence interval (CI) were calculated. Publication bias was detected by funnel plots and Egger's test, and trim-and-fill analysis was employed when publication bias existed.
Results:
A total of 13 studies reporting 2441 HCM patients were included in this meta-analysis. Absolute value of LVGLS was lower in the group of HCM with MACE (MD = 2.74, 95% CI: 2.50-2.99, p < .001; I2 = 0, p = .48). In the pooled unadjusted model, LVGLS was related to MACE (HR = 1.14, 95% CI: 1.06-1.22, p < .05, I2 = 58.4%, p < .01) and there is a mild heterogeneity, and sensitivity analysis showed stable results. In the pooled adjusted model, LVGLS was related to MACE (HR = 1.12, 95% CI: 1.08-1.16, p < .05; I2 = 0%, p = .442). Egger's tests showed publication bias, and trim-and-fill analysis was applied, with final results similar to the previous and still statistically significant.
Conclusion:
The meta-analysis suggested that impaired LVGLS was associated with poor prognosis in HCM patients.
