{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:15:06Z","timestamp":1787724906015,"version":"build-2784847793"},"reference-count":41,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,10,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Three\u2010dimensional (3D) speckle tracking echocardiography can identify subclinical diabetic cardiomyopathy without geometric assumption and loss of speckle from out\u2010of\u2010plane motions. There is, however, significant heterogeneity among the previous reports. We performed a systematic review and meta\u2010analysis to compare 3D strain values between adults with asymptomatic, subclinical diabetes mellitus (ie, patients with diabetes mellitus without known clinical manifestations of cardiac disease) and healthy controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      After systematic review of 5 databases, 12 valid studies (544 patients with diabetes mellitus and 489 controls) were eligible for meta\u2010analysis. Pooled means and mean difference (MD) using a random\u2010effects model for 3D global longitudinal, circumferential, radial, and area strain were calculated. Patients with diabetes mellitus had an overall 2.31 percentage points lower 3D global longitudinal strain than healthy subjects (16.6%, 95% CI, 15.7\u201317.6 versus 19.0; 95% CI, 18.2\u201319.7; MD, \u22122.31, 95% CI, \u22122.72 to \u22122.03). Similarly, 3D global circumferential strain (18.9%; 95% CI, 17.5\u201320.3 versus 20.5; 95% CI, 18.9\u201322.1; MD, \u22121.50; 95% CI, \u22122.09 to \u22120.91); 3D global radial strain (44.6%; 95% CI, 40.2\u201349.1 versus 48.2; 95% CI, 44.7\u201351.8; MD, \u22123.47; 95% CI, \u22124.98 to \u22121.97), and 3D global area strain (30.5%; 95% CI, 29.2\u201331.8 versus 32.4; 95% CI, 30.5\u201334.3; MD, \u22121.76; 95% CI, \u22122.74 to \u22120.78) were also lower in patients with diabetes mellitus. Significant heterogeneity was noted between studies for all strain directions (inconsistency factor [I\n                      <jats:sup>2<\/jats:sup>\n                      ], 37%\u201378%). Meta\u2010regression in subgroup analysis of studies using the most popular vendor found higher prevalence of hypertension as a significant contributor to worse 3D global longitudinal strain. Higher hemoglobulin A\n                      <jats:sub>1c<\/jats:sub>\n                      was the most significant contributor to worse 3D global circumferential strain in patients with diabetes mellitus.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Three\u2010dimensional myocardial strain was reduced in all directions in asymptomatic diabetic patients. Hypertension and hemoglobin A\n                      <jats:sub>1c<\/jats:sub>\n                      were associated with worse 3D global longitudinal strain and 3D global circumferential strain, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.crd.york.ac.uk\/prospero\">https:\/\/www.crd.york.ac.uk\/prospero<\/jats:ext-link>\n                      ; unique identifier: CRD42020197825.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.121.020811","type":"journal-article","created":{"date-parts":[[2021,9,29]],"date-time":"2021-09-29T05:26:53Z","timestamp":1632893213000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Three\u2010Dimensional Global Left Ventricular Myocardial Strain Reduced in All Directions in Subclinical Diabetic Cardiomyopathy: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1161","volume":"10","author":[{"given":"Seyed\u2010Mohammad","family":"Ghoreyshi\u2010Hefzabad","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Health Charles Perkins Centre Nepean Sydney Medical School NepeanThe University of Sydney Kingswood Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prajith","family":"Jeyaprakash","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Charles Perkins Centre Nepean Sydney Medical School NepeanThe 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