Use of Speckle Tracking Echocardiography to Predict Right Heart Failure Following Left Ventricular Assist Device Implantation: A Systematic Review and Meta-Analysis

Introduction Right Heart Failure (RHF) is an important consequence of implant of left ventricular assist devices (LVAD). Right ventricular (RV) analysis with speckle tracking echo (STE) can assist in the assessment of the RV. This meta-analysis examines preoperative RV strain on STE as a predictor of postoperative RHF. Methods Literature was reviewed in Pubmed, EMBASE, and Web of Science for studies reporting on the association of preoperative RV free wall (FWS), global longitudinal (GLS), and septal longitudinal (SLS) strain with postoperative RV failure following LVAD placement. Strain parameters were compared between the two groups. Results A total of 13 studies with 933 patients undergoing LVAD implantation met inclusion criteria. 254 patients subsequently developed RHF and 679 did not develop RHF. Mean follow up was 15 months. The mean age of participants was 55.9 years and 85% were male. Baseline RVFWS, RVGLS, and RVSLS were significantly reduced in patients who developed post-implantation RHF compared to patients who did not develop post-implantation RHF (MD 3.77, 95% CI 2.39, 5.15; p<0.01; MD 2.67, 95% CI 1.16, 4.17; p<0.01; MD 3.59, 95% CI 0.83, 6.35; p=0.01). The heterogeneity was considerable for all three analyses (RVFWS I2=88%, RVGLS I2=92%, RVSLS I2=83%), likely due to vendor-specific differences in strain measurements and differences in echocardiography lab protocols. To address this, a random-effects model was used. Conclusions Preoperative RV FWS, GLS, and SLS were all associated with postoperative RHF. STE may be helpful in risk stratification of RHF following LVAD implant.