| Background:Aortic valve replacement(AVR)is one of the most effective therapeutic modalities to help relieving symptoms,improving living quality and prolonging life in patients with severe aortic stenosis(AS).Nevertheless,the immediate and long-term effects of AVR on left ventricular(LV)systolic function are incompletely defined.It is also unclear whether AVR leads to improvement of LV systolic function or whether reduced preoperative left ventricular function has effects on long-term outcome.Global longitudinal strain(GLS)utilizing speckle-tracking echocardiography is a novel,sensitive method for assessing left ventricular function and may be useful for detecting subclinical myocardial systolic dysfunction.In this study,a meta-analysis was performed to identify the dynamics of left ventricular global longitudinal strain(LVGLS)and its prognostic impact in patients with severe AS treated with AVR.Methods:An English-language literature search was performed in PubMed,Embase,Web of Science,Cochrane Library and Scopus database from inception to November 2021.We screened original studies that using GLS to evaluate left ventricular function and to predict outcomes after AVR.The change of myocardial deformation of the left ventricle before and after AVR were evaluated.GLS was used to predict postoperative mortality and adverse outcomes.Two researchers analyzed and extracted data according to literature screening criteria respectively,and statistically analyzed the results using STATA 14.0 and Revman 5.3.Results:A total of 554 research works were retrieved in literature search.After literature screening and quality evaluation,a total of 26 observational studies related to this meta-analysis were included,including 4015 patients.The summary results show that:① LVGLS improves after AVR when compared to that at baseline,with mean difference(MD)=-2.12,95%confidence interval(CI)[-2.57,-1.67],P<0.0001 and I2=75%.While GLS improves in patients with normal LVEF at baseline,(standard mean difference(SMD)=0.24,95%CI[0.06,0.43],P=0.009),LVEF does not show a substantial change(SMD=-0.02,95%CI[-0.20,0.16],P=0.59),suggesting LVGLS is a better marker in detecting potential left ventricular systolic dysfunction.② Baseline LVGLS has a direct correlation with the postprocedural outcomes.1)Worse baseline LVGLS associated with significant increase in all-cause mortality and major adverse cardiac events(MACE),with hazards ratio(HR)=1.08,95%CI[1.05,1.10],P<0.0001 and I2=3%.2)Compared with non-survivors,survivors have more negative baseline LVGLS values(better left ventricular function),with MD=-1.83,95%CI[-2.61,-1.04],P<0.0001 and I2=0%.3)Patients with clinical events have less negative baseline LVGLS(worse left ventricular function)as compared with patients without events,with MD=3.14,95%CI[2.60,3.67],P<0.0001 and I2=37%.③The relative change of LVGLS after AVR tends to reduce the risk of all-cause mortality,but the result is not statistically significant(HR=0.98,95%CI[0.91,1.06],P=0.68,12-70%).Conclusions:Although the change of LVGLS does not show a correlation with postprocedural all-cause mortality,baseline LVGLS predicts mid-long term survival and clinical events.Additionally,LVGLS improves after AVR,signaling a reversible recovery of left ventricular systolic function.Thus,LVGLS may be a valuable parameter for a tailored follow-up of left ventricular function in patients with severe aortic stenosis undergoing AVR. |
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