Speckle‑tracking echocardiographic abnormalities in chronic obstructive pulmonary disease: a systematic review and meta‑analysis

Abstract

Chronic obstructive pulmonary disease (COPD) is known to be associated with cardiovascular disease due to shared risk factors and its impact on the cardiopulmonary vasculature. Speckle-tracking echocardiography (STE) is an effective tool for identifying subclinical, COPD-associated right ventricular (RV) and left ventricular (LV) dysfunction before conventional echocardiography can detect it. A systematic review and meta-analysis of the literature on STE in COPD are presented. A systematic search was conducted of PubMed, Scopus, Cochrane Library, and Science Direct for papers published between 2011 and March 2023, and bias was assessed using the STROBE tool. Eleven studies were included in the two-stage meta-analysis: first among 742 COPD cases, and then a case–control design with 507 COPD cases and 259 healthy controls. Of the 11 studies analyzed, 6 were dedicated to the assessment of RV strain, and 5 studies examined LV global longitudinal strain (GLS). Significant heterogeneity was observed in the STE parameters of COPD patients ( I2 = 95%; mean effect size: –17.055 for LV GLS and –19.098 for RV free wall strain; Z = –35.809; P < 0.001) and between COPD patients and controls ( I2 = 92%; mean effect size, 2.100; Z = 8.433; P < 0.0001). LV and RV STE parameters were lower in the COPD group than in the healthy control group. The two-dimensional STE parameters correlated with disease severity metrices such as the BODE (body mass index, airflow obstruction, dyspnea, and exercise) index and Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, and they predicted mortality, hospitalization rates, and exercise tolerance in COPD patients. STE abnormalities are prevalent in COPD patients and can help identify subclinical LV and RV dysfunction. The presence of STE abnormalities helps in prognostication for COPD patients.