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Cardiac involvement assessment in systemic sclerosis using speckle tracking echocardiography: a systematic review and meta-analysis
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Other responses

  • Published on:
    Author response to: Comment on: Cardiac involvement assessment in systemic sclerosis using speckle tracking echocardiography: a systematic review and meta-analysis
    • Dr Yangjie Xiao, Department of Ultrasound Shengjing Hospital of China Medical University

    Dear Editor,

    Thank you for providing us with the opportunity to respond to Dr. Peverill’s comment concerning our article entitled “Cardiac involvement assessment in systemic sclerosis using speckle tracking echocardiography: a systematic review and meta-analysis”. We also acknowledge and appreciate Dr. Peverill’s time spent reading our article and providing his comments to help us strengthen the article.
    As proposed by Dr. Peverill and also stated in the article, our systematic review was conducted because of results from related studies were controversial. Based on the meta-analysis results, we found left ventricular (LV) global longitudinal strain (GLS) was lower in SSc patients than in healthy control subjects. We are sorry we included multiple sclerosis in the study by mistake. We will correct it as soon as possible with the help of our editors. As for the reported large standard deviation (SD) of GLS of 8.9% in the control group 1, we have carefully reviewed the article again, and this value has been mentioned many times and is difficult to identify as an error. Moreover, as suggested by Dr. Peverill, we will present the result with the study excluded in the supplementary file.

    As Dr. Peverill suggests, age and sex may affect GLS. The effects of age and sex on the results of SSc and control groups need to be considered, however most studies include age- and sex- matched control groups [2-7], which may reduce the effect. In our study, we also perfor...

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    Conflict of Interest:
    None declared.
  • Published on:
    Cardiac assessment in systemic sclerosis
    • Roger Peverill, Cardiologist Victorian Heart Hospital, Monash Health, Clayton, Victoria, Australia

    In the meta-analysis and systematic review by Qiao et al regarding the assessment of cardiac involvement in systemic sclerosis (SSc) using speckle tracking echocardiography the authors have reported that left ventricular (LV) global longitudinal strain (GLS) is lower in SSc patients than in healthy control subjects 1. While not specifically stated by the authors, it could possibly be concluded from this finding that there is now evidence to support performance of GLS during the screening of SSc patients and the use of this GLS result for early diagnosis of myocardial involvement. However, there are a number of reasons why such a conclusion should be considered premature. (1) There remain significant discrepancies in the literature with respect to the effect of SSc on GLS which require explanation but have not been explained by this meta-analysis. Moreover, errors have been made in study selection, with one particularly concerning error being that one of the included studies is actually a study of multiple sclerosis, not systemic sclerosis 2. A further error is that one of the other included studies reported a standard deviation (SD) of GLS of 8.9% in the control group, a very large number which suggests substantial errors of GLS measurement in this group and should therefore have invalidated its inclusion 3. (2) In healthy subjects the absolute value of GLS decreases with age and is higher in females 4. This is of particular importance for any study of SSc given that patie...

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    Conflict of Interest:
    None declared.