In healthy subjects, the pooled lower limit of normal for two-dimensional right ventricular global longitudinal strain was -16.4%, establishing a reference threshold for abnormal strain.
Meta-Analysis (n=4,439)
What are the normal reference ranges for right ventricular systolic strain by echocardiography in healthy subjects?
This meta-analysis establishes the pooled means and lower limits of normal for 2D and 3D right ventricular systolic strains in healthy subjects, providing thresholds for clinical use.
BACKGROUND: Right ventricular (RV) systolic strain has recently demonstrated prognostic value in various cardiovascular diseases. Despite this, the reference range including the lower limit of normal (LLN) and factors associated with RV strain measurements are not well-established. This meta-analysis aimed to determine the mean and LLN of two- (2D) and three-dimensional (3D) right ventricular global (RVGLS), free wall (RVFWLS) and interventricular septal wall (IVSLS) longitudinal strains in healthy individuals and factors that affect strain measurements. METHODS: In this meta-analysis, Pubmed, Embase and Cochrane databases were searched until 31 July 2020 for eligible studies reporting RVGLS, RVFWLS and/or IVSLS in at least 30 healthy subjects. We pooled the means and LLNs of RV strains by two- (2D) and three- (3D) dimensional echocardiography, and performed meta-regression analyses. RESULTS: From 788 articles screened, 45 eligible studies totaling 4439 healthy subjects were eligible for analysis. Pooled means and LLNs with 95% confidence intervals for 2D- RV strains were RVGLS -23.4% (-24.2%, -22.6%) and -16.4% (-17.3%, -15.5%) in 27 studies; RVFWLS -26.9% (-28.0%, -25.9%) and -18.0% (-19.2%, -16.9%) in 32 studies; and IVSLS -20.4% (-22.0%, -18.9%) and -11.5% (-13.6%, -9.6%) in 10 studies, and similar results for 3D- RV strains. Right ventricular fractional area change and vendor software were associated with 2D-RVGLS and RVFWLS means and LLNs. CONCLUSION: We reported the pooled means and LLNs of RV systolic strains in healthy subjects, to define thresholds for abnormal, borderline and normal strains. Important factors associated with RV systolic strains include right ventricular fractional area change and vendor software.
Wang et al. (Fri,) conducted a meta-analysis in Healthy subjects (n=4,439). Two-dimensional right ventricular global longitudinal strain (2D-RVGLS) measurement was evaluated on Pooled lower limit of normal (LLN) for 2D-RVGLS (95% CI -17.3%, -15.5%). In healthy subjects, the pooled lower limit of normal for two-dimensional right ventricular global longitudinal strain was -16.4%, establishing a reference threshold for abnormal strain.
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