Speckle tracking echocardiographic abnormalities in chronic obstructive pulmonary disease: insights from a systematic review and meta-analysis
Authors: Ranjini N V , Sunil Kumar S , Nagaraj D E S A I , Mahesh P A , Chaithra N , Harsha Chalasani S R I , Pal N I K I T A , Abdul Hafeez S Y E D , Chaya S K 
Published: January 2025

Abstract

Background
Speckle tracking echocardiography (STE) is the most effective tool to describe the cyclic deformation of the myocardium offering a better insight into myocardial dysfunction and providing valuable prognostic information.1 Chronic obstructive pulmonary disease (COPD) has a direct impact on heart and pulmonary vasculature. Subclinical ventricular dysfunction is present in COPD even before conventional echocardiography can detect it.2,3

Purpose
We conducted a systematic review and meta-analysis of the available literature on STE parameters to evaluate subclinical right and left ventricular dysfunction in COPD.

Methods
A systematic search was performed in the PubMed, Scopus, Cochrane Library, and ScienceDirect databases from 2011 to March 2023. Two independent investigators reviewed the results. The study findings are presented under PRISMA recommendations. To search the databases, search phrases and Boolean operators were employed. Boolean operators, such as "AND","OR," and "NOT" are used to combine or exclude search words. A comprehensive search was conducted using keywords and the studies that measured the STE parameters in COPD patients with no cardiac comorbidities were included in a meta-analysis, and pooled measures were obtained. The risk of bias was assessed using the STROBE Quality Assessment Tool.

Results
Eleven studies were included in the meta-analysis. The STROBE score among the 11 articles ranged between 18 to 21. A total of 742 subjects with COPD were studied out of which 74.4% were male and 25.6% were female. The average age among the studies was 64.20 ± 7.15 years. The meta-analysis was conducted in two stages. At first, the meta-analysis was conducted among the 742 COPD cases. A second-stage meta-analysis was performed with a case-control study design of 507 COPD cases and 259 healthy control groups. STE revealed that LV global longitudinal strain (GLS) and RV free wall strain (FWS) parameters in COPD patients (mean effect size: - 17.055 with a 95% CI: -18.395 to -15.715; mean effect size: -19.098 with a 95% CI: -20.064 to -18.131). STE parameters in COPD patients with a mean effect size = 2.100, 95% CI: 1.612 to 2.588 were significantly reduced compared to the control group. Egger’s test results showed that publication bias was not a concern for these studies [p = 0.282]. The average RVFWS and RV GLS were -18.59 ± 4.07 and -17.48 ± 3.65 respectively. The average LV GLS was -17.43 ± 3.03. The average values of STE parameters were significantly lower in COPD patients compared to healthy controls, and these values decreased even more with the progression of COPD severity. Additionally, the presence of STE abnormalities was associated with poorer outcomes in COPD patients.

Conclusions
Speckle tracking echocardiographic abnormalities are quite prevalent and portends poor prognosis in COPD patients. STE helps identify subclinical LV and RV dysfunction before conventional echocardiographic abnormalities are evident.