Prognostic value of absolute global longitudinal strain for chemotherapy-related cardiac dysfunction in breast cancer patients: a systematic review and meta-analysis.

OBJECTIVE

To determine the general predictive effect of absolute global longitudinal strain (GLS) in predicting chemotherapy-induced cardiotoxicity (CTRCD) for breast cancer patients.

METHODS

A systematic literature search was conducted on the PubMed, Embase, Cochrane Library, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), Wanfang and VIP databases to identify cohort studies published up to May 31, 2026, on the application of GLS for predicting CTRCD in breast cancer patients undergoing chemotherapy. Two researchers independently carried out the article filtering, data collection and quality assessment. RevMan 5.4 and Stata 18.0 software were used for meta-analysis; the size of the general effect was presented as an odds ratio (OR), and a hierarchical summary receiver operating characteristic (HSROC) curve was constructed to assess diagnostic accuracy. Subgroup analysis and meta-regression were used to identify the sources of heterogeneity; sensitivity analysis was conducted by a stepwise exclusion strategy; and a funnel plot was employed to examine publication bias.

RESULT: 12 papers included data from 955 breast cancer patients. A meta-analysis indicated that the odds of being affected by CTRCD were significantly higher in the low-GLS group (absolute drop in GLS) compared with the high-GLS group (OR = 11.88, 95% CI: 7.88-17.92, P<0.00001), and there was low heterogeneity across trials (I2 = 18%, P = 0.26). The area under the HSROC curve (AUC) was 0.86 (95% CI: 0.82-0.89), and the combined sensitivity and combined specificity were 83.0% and 73.0% (95% CI: 75.4%-88.6%, 95% CI: 65.1%-79.6%), respectively. Subgroup analysis and meta-regression showed that research type, breast cancer subtype and the CTRCD definition were not significant sources of heterogeneity (all P>0.05). Exclusion of one study at a time in sensitivity analysis did not change the combined results. The funnel plot was symmetrical, and therefore publication bias is likely not present.

CONCLUSION

the absolute GLS value can be used as a good prognostic index for chemotherapy-induced CTRCD in breast cancer patients, and a lower absolute GLS is associated with a significantly increased risk of CTRCD. An index has been developed to determine the risk of damage to the heart muscle after chemotherapy in breast cancer at a specific time, and scientific support will be provided for treatment decisions.