Association of left ventricular global longitudinal strain with poor clinical outcome in covid-19: A systemic review and meta-analysis

ABSTRACT

Introduction: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared a global pandemic by the World Health Organization (WHO) in March 2020. Although left ventricular global longitudinal strain (LV-GLS) has been validated as a prognostic marker in other disease processes, the utility of LV-GLS in risk stratification of coronavirus disease 2019 (COVID19) remains controversial. This study aimed to investigate the prognostic value of echocardiographic findings, including LV-GLS in patients with COVID-19. Hypothesis: LV-GLS is associated with poor clinical outcomes in patients with COVID-19. Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to June 2021. Included studies were published observational studies that reported an association between echocardiographic findings and prognostic valve in COVID-19. Data from each study were combined with random-effects, generic inverse variance method of DerSimonian and Laird to calculate pooled odds ratios and their 95% confidence intervals at 0.05 significance level. Sensitivity analysis and funnel plot were assessed for the validity of the results. Results: Six observational studies from August 2020 to May 2021 were included in this metaanalysis. The pooled odds ratio for COVID-19 mortality for each 1% change in LV-GLS was 1.452 (95% confidence interval 1.186 to 1.778, P < 0.001). There was moderate heterogeneity with an Isquare value of 49.9%. Sensitivity analysis showed no significant deviation from pooled odds ratios. There was no evidence of publication bias from the funnel plot and Egger's test. Conclusions: LV-GLS measurement has prognostic value in risk stratification among COVID-19 patients. Low LV-GLS is independently associated with poor clinical outcomes.