Right ventricular strain assessed by two-dimensional speckle tracking echocardiography and mortality in acute respiratory distress syndrome: a systematic review and meta-analysis.

Background We investigated differences in right-ventricular cardiac strain between survivor and non-survivor acute respiratory distress syndrome (ARDS) patients as measured by speckle tracking echocardiography.Methods We conducted a systematic search of PubMed and Scopus for relevant articles reporting data on all-cause mortality and right cardiac speckle tracking echocardiography in ARDS patients. We considered studies published up to May 4, 2025. The primary objectives of the meta-analysis were right-ventricular global and free-wall strain. A random effects model was used.Results We included 6 studies with a total population of 359 individuals. While right ventricular global longitudinal strain of intubated ARDS patients (mean difference [95% CI], -2.30 [-4.13 to -0.47], P=0.01) was greater among non-survivors, free wall strain [mean difference [95% CI], -2.78 [-6.83 to 1.27], P=0.18) was similar among groups. Among classic right ventricular echocardiographic indices, S prime and fractional area of change were lower among non-survivors, while still within normal range, while tricuspid annular plane systolic excursion was similar between groups. When exploring heterogeneity, we observed that removing outlier studies indicated consistently worse baseline right ventricular function among both strain and non-strain parameters.Conclusions Although right ventricular function appears to be worse among non-survivor ARDS patients, results vary due to high heterogeneity among published studies. The role of right ventricular speckle tracking echocardiography as a non-invasive bedside means of quantifying myocardial dysfunction and predicting patient outcomes remains to be explored further in future trials.