Impact of cardiovascular magnetic resonance-derived right ventricular ejection fraction on adverse outcomes: A robust Bayesian model-averaged meta-analysis

There are few meta-analyses examining the prognostic value of right ventricular ejection fraction (RVEF) for a specific type of cardiovascular disease (CVD). The aim of this study was to compare the association of cardiac magnetic resonance (CMR)-derived RVEF with adverse outcomes for several specific types of CVD, using a robust Bayesian model-averaged meta-analysis. Three databases were searched for CMR articles reporting hazard ratios (HRs) of RVEF restricted to a specific type of CVD. For each specific type of CVD, Bayesian model-averaged meta-analyses with and without publication bias adjustments were conducted to evaluate the strength of evidence for RVEF according to the Bayes factor (BF). Among 108 articles (21,166 patients) analyzing 11 CVD types, pooled HR for 5% reduction in RVEF assessed by publication bias-unadjusted, Bayesian model-averaged meta-analysis offered moderate or strong evidence of an association with outcomes for all types of CVD (HR: 1.07–1.37, BF 10 : 4.3–9.6 * 10 7 ). In contrast, a robust Bayesian model-averaged meta-analysis, adjusted for publication bias, found moderate or strong evidence in favor of an association of RVEF with outcomes only in hypertrophic cardiomyopathy (HR: 1.19, 95% credible interval (CrI): 0.98–1.42, BF 10 : 5.0), dilated cardiomyopathy (HR: 1.16, 95% CrI: 1–1.22, BF 10 : 23.3), pulmonary hypertension (HR: 1.05, 95% CrI: 1–1.12, BF 10 : 3.0), and aortic stenosis (HR: 1.15, 95% CrI: 0.97–1.34, BF 10 : 4.2). There was weak evidence for an association of RVEF with adverse outcomes in seven other CVDs. In a Bayesian meta-analysis adjusted for publication bias, there was moderate or strong evidence for an association of RVEF with outcomes for only four CVDs. Additional data may strengthen evidence regarding other CVDs. Scatterplots of Bayes factor and HR scales for RVEF in specific types of cardiovascular disease using robust Bayesian model-averaged meta-analysis. The x-axis represents the Bayes factor with a log 10 scale, and the y-axis represents HR. Sizes of circles for CVDs represent sample size. AS aortic stenosis, DCM dilated cardiomyopathy, HCM hypertrophic cardiomyopathy, HFpEF heart failure with preserved ejection fraction, HFrEF heart failure with reduced ejection fraction, MI.