The Role of Speckle-Tracking Echocardiography in Predicting Mortality and Morbidity in Patients With Congenital Heart Disease: A Systematic Review and Meta-analysis

Abstract

Background Speckle tracking echocardiography (STE) is now routinely included in cardiac evaluations, but its role in predicting mortality and morbidity in congenital heart disease (CHD) is not well described. We conducted a systematic review to evaluate the prognostic value of STE in patients with CHD. Methods EMBASE, Medline, Web of Science, Scopus and CENTRAL databases were searched from inception to January 2023, for terms related to all CHD, STE and prognosis. Meta-analysis of association of right ventricle and left ventricle strain (RV- Sl and LV- Sl respectively) associations with major adverse cardiovascular events (MACE) was performed in atrial switch transposition of the great arteries (asTGA)/congenitally corrected TGA (ccTGA), tetralogy of Fallot (ToF) and congenital aortic stenosis (cAS)/bicuspid aortic valve (BAV). P-value combination analysis was additionally performed for all CHD groups. Results A total of 33 studies (30 cohorts, n=8619 patients, children, and adults) were included. Meta-analysis showed the following parameters being associated with MACE: RV-Sl in asTGA/ccTGA (hazard ratio [HR]=1.1/% [1.03; 1.18]), RV-Sl and LV-Sl in ToF (HR=1.14/% CI [1.03;1.26] and HR=1.14/% CI [1.08;1.2], respectively) and LV-Sl in cAS/BAV (HR=1.19/% [1.15; 1.23]. RV-Sl and strain rate were associated with outcomes also in single ventricle (SV)/hypoplastic left heart syndrome (HLHS) (at all palliation stages except before Norwood Stage 1) and LV-Sl in Ebstein’s anomaly. Conclusions This systematic review and meta-analysis showed that biventricular strain and strain rate were associated with outcomes in a variety of CHD highlighting the need for updated recommendations on the use of STE in the current guidelines, specific to disease types.

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