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What is Left Ventricular Strain in Healthy Neonates? A Systematic Review and Meta-analysis

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Abstract

Reference values for left ventricular systolic strain in healthy neonates are necessary for clinical application of strain. The objectives of this systematic review were to identify echocardiographic studies that presented left ventricular strain values in healthy neonates, perform a meta-analysis for speckle tracking-derived global longitudinal strain, and identify areas that require further investigation. A structured search was applied to MEDLINE, Embase, and Cochrane Central Register of Clinical Trials in search of echocardiographic studies that presented left ventricular strain in healthy neonates. 244 studies were identified, of which 16 studies including speckle tracking and tissue Doppler strain in the longitudinal, radial, and circumferential directions passed the screening process. Out of these 16 studies, a meta-analysis was performed on the 10 studies that reported speckle tracking global longitudinal strain. Mean speckle tracking-derived global longitudinal strain was 21.0% (95% Confidence Interval 19.6–22.5%, strain given as positive values). When the studies were divided into subgroups, mean speckle tracking global longitudinal strain from the four-chamber view was 19.5% (95% Confidence Interval 18.0–21.0%) and that derived from all three apical views was 22.5% (95% CI 20.6–24.7%), indicating that global longitudinal strain from the four-chamber view is slightly lower than global longitudinal strain from all three apical views. Neonatal strain values were close to strain values in older subjects found in previous meta-analyses. Further studies are recommended that examine strain rate, segmental strain values, strain derived from short axis views, and strain in the first few hours after birth.

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Acknowledgements

We would like to thank Regina Küfner Lein, Librarian at the University Library of Bergen, for her invaluable contribution in identifying the appropriate databases and developing a search strategy.

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  1. Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021, Bergen, Norway

    Umael Khan, Knut Matre & Gottfried Greve

  2. Department of Heart Disease, Haukeland University Hospital, Bergen, Norway

    Tom R. Omdal & Gottfried Greve

  3. WestPaedResearch, Department of Clinical Science, University of Bergen, Bergen, Norway

    Tom R. Omdal & Gottfried Greve

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Khan, U., Omdal, T.R., Matre, K. et al. What is Left Ventricular Strain in Healthy Neonates? A Systematic Review and Meta-analysis. Pediatr Cardiol 41, 1–11 (2020). https://doi.org/10.1007/s00246-019-02219-8

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