The role of global longitudinal strain in predicting fatal arrhythmic events in hypertrophic cardiomyopathy: An up-to-date systematic review and Meta-analysis

Sudden cardiac death (SCD) remains a leading cause of mortality in patients with hypertrophic cardiomyopathy (HCM). Accurate identification of individuals at high risk is essential for guiding implantable cardioverter-defibrillator (ICD) therapy. Global longitudinal strain (GLS), an echocardiographic parameter derived from speckle-tracking imaging, reflects subclinical left ventricular systolic dysfunction and may serve as an adjunctive risk marker for fatal ventricular arrhythmias (VAs). A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed and the Cochrane Library were searched from inception to April 2025 for studies assessing the association between GLS and SCD and/or fatal VAs in HCM. Out of 1050 identified records, seven studies comprising 2167 patients (mean age 54.7 years) met inclusion criteria. All included studies were of moderate-to-high quality (Newcastle-Ottawa Scale ≥6). In the pooled quantitative synthesis of three studies, patients with reduced GLS (