Diagnostic and Prognostic Value of Global Longitudinal Strain in Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-Analysis

Objective Heart failure with preserved ejection fraction (HFpEF), an increasing public health concern, is increasing in prevalence and is associated with an elevated risk of hospitalization and mortality. Currently, data on the clinical application value of left ventricular global longitudinal strain (LV GLS) in HFpEF are contradictory. Therefore, we performed the following meta-analysis to appraise the diagnostic and prognostic value of LV GLS in HFpEF. Methods PubMed, Medline, Scopus, and Web of Science were retrieved exhaustively from their inception until December 20, 2022, to obtain literature assessing the diagnostic and prognostic value of LV GLS in HFpEF. Results Forty-one studies (including 14,543 patients) published from 2008 to 2022 were included. The results of the meta-analysis were as follows: First, the LV GLS values in HFpEF patients were significantly lower than in healthy individuals (SMD:1.21; 95% CI (0.94, 1.47), p<0.00001, I2=85%; P<0.00001), but substantially higher than in HErEF patients (SMD: -2.03; 95% CI (−2.23, -1.72), p<0.00001, I2=92%; P<0.00001). Second, the pooled diagnostic parameters of LV GLS for HFpEF were as follows: sensitivity, 0.77 (95% CI: 0.71–0.82); specificity, 0.66 (95% CI: 0.58–0.74); DOR, 7.53 (95% CI: 3.19–17.74); AUC for the SROC, 0.81 (95% CI: 0.79–0.87). Finally, the low LV GLS values were correlated with a higher risk of all-cause death (HR: 1.12; 95% CI: 1.01-1.25; p=0.000, I2=84%; P = 0.031) in HFpEF patients. Conclusions LV GLS is impaired in HFpEF patients despite a normal left ventricular ejection fraction, indicating the existence of mild LV contractile dysfunction. Moreover, LV GLS might be an auxiliary indicator for diagnosing HFpEF and predicting all-cause death in HFpEF patients. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement No ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: N/A I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All relevant data are within the paper.