Accepted for/Published in: JMIR Research Protocols
Date Submitted: Jan 16, 2025
Date Accepted: May 26, 2026
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Global Longitudinal Strain and Brain Natriuretic Peptide as Prognostic Biomarkers for Asymptomatic Severe Aortic Regurgitation with Preserved Ejection Fraction: A Protocol for Systematic Review and Meta-Analysis
ABSTRACT
Background:
The brain natriuretic peptide (BNP) and global longitudinal strain (GLS) are emerging biomarkers used to risk stratify patients with asymptomatic severe AR with preserved ejection fraction (EF). While numerous clinical trials have investigated the efficacy of these biomarkers in patients with aortic stenosis, only a limited number examined these biomarkers in patients with aortic regurgitation (AR). Therefore, the proposed systematic review and meta-analysis seeks to assess the prognostic value of BNP and/or GLS in patients with severe asymptomatic AR and preserved EF.
Objective:
This is a protocol manuscript for a systematic review and meta-analysis which will collect and synthesize high-quality clinical data on the usefulness of BNP and GLS as prognostic indicators for asymptomatic severe AR with preserved EF. By providing a comprehensive review, our study will have a significant impact in determining surgical candidacy in this patient population.
Methods:
In accordance with the PRISMA framework, a comprehensive search of databases, including PubMed, Cochrane and Embase will be performed to retrieve peer-reviewed, English-only, observational and experimental studies published from inception to November 2024. Studies which investigated patients aged 18+ years and having severe AR with normal EF will be included. The National Heart, Lung and Blood Institute (NHLBI) tool will be utilized to assess the quality of the studies.
Results:
The development and refinement of the search strategy took place in November 2024 and currently we are working on selection of the articles. Screening and full-texts’ retrieval are expected to be completed by April 2025. Data extraction, summarization, and risk of bias assessment will be conducted in May 2025. Meta-analysis and manuscript writing will take place between June-August 2025.
Conclusions:
Both BNP and GLS are cost-effective and if these two biomarkers demonstrate superior prognostic potential compared to LV ejection fraction for risk stratification in patients with asymptomatic severe AR and preserved EF, they could significantly enhance the healthcare practice. Clinical Trial: CRD42024579540
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