Myocardial Performance Index to assess cardiac function in autoimmune connective tissue disease: A systematic review and meta-analysis

Objectives This study aimed to evaluate cardiac function using Myocardial Performance Index (MPI) in autoimmune connective tissue disease (ACTD) patients without cardiovascular abnormalities. Methods A systematic search of databases including Medline, Google Scholar, ProQuest, Scopus and Cochrane Library was conducted to identify relevant studies on ACTD and MPI from 1995 to 2023. ACTD included in the search were rheumatoid arthritis (RA), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), Sjögren syndrome (SjD), polymyositis and dermatomyositis. Quality assessment was performed using the Newcastle-Ottawa Scale, followed by meta-analysis computation of mean differences (MDs) of MPI using Review Manager V.5.4. Results A total of 22 studies for qualitative and 19 for quantitative synthesis were included. We found six studies on RA, eight studies on SSc, five studies on SLE, two studies on SjD and one on mixed connective tissue disorder. Conventional echocardiography and tissue Doppler imaging (TDI) were used to assess the MPI. Both conventional MPI and tissue Doppler MPI values were elevated compared with healthy control (MD=0.11, 95% CI 0.08 to 0.14, p value<0.00001 and MD=0.06, 95% CI 0.03 to 0.10, p value=0.00001, respectively). Conclusions We found elevated MPI values in patients with ACTD compared with healthy controls. MPI assessment has the potential for early detection and management of cardiac dysfunction in patients with ACTD, but further studies are required to corroborate these findings. PROSPERO registration number CRD42023490643.