Right ventricular echocardiographic parameters in cardiac amyloidosis compared with healthy individuals: systematic review and meta-analysis

Introduction Cardiac amyloidosis (CA) is a progressive infiltrative cardiomyopathy caused by extracellular deposition of amyloid fibrils within the myocardium, resulting in structural remodelling and biventricular dysfunction. While left ventricular involvement has been extensively characterised, right ventricular (RV) impairment, a recognised contributor to adverse outcomes in CA, has received comparatively little systematic attention. To our knowledge, no prior meta-analysis has quantified RV echocardiographic alterations in this condition, leaving a critical evidence gap in the multimodal assessment of CA. Purpose To address this unmet need, we conducted a systematic review and meta-analysis quantifying differences in routine RV transthoracic echocardiographic parameters between patients with CA and healthy controls, with the aim of informing standardised echocardiographic protocols for CA. Methods A comprehensive systematic review was performed in accordance with PRISMA guidelines. Studies comparing routine RV echocardiographic parameters in CA patients and healthy controls were synthesised using random-effects meta-analysis with restricted maximum likelihood (REML) estimation. Continuous variables were analysed as standardised mean differences (SMDs). Median values were converted to means and standard deviations, and amyloid subgroups were pooled. Results Of 7,305 studies screened, 14 met inclusion criteria, encompassing 1,576 patients. CA was associated with substantial alterations in RV structure and function relative to healthy controls. The largest effect sizes were observed for RV free wall thickness (SMD 1.65, 95% CI 1.25–2.05), RV free wall strain (SMD 1.56, 95% CI 0.76–2.37), and RV systolic pressure (SMD 1.32, 95% CI 0.93–1.71). Conversely, systolic function was markedly impaired, evidenced by reductions in TAPSE (SMD −1.51, 95% CI −1.71 to −1.31), RV ejection fraction (SMD −1.00, 95% CI −1.39 to −0.61) and RV fractional area change (SMD -0.66, 95% CI -1.16 to -0.17). RV end-diastolic diameter did not differ significantly between groups (SMD 0.12, 95% CI −0.18 to 0.41). Inter-study heterogeneity ranged from low to substantial (I² 0–91.7%). Full results are presented in Table 1. Conclusion This systematic review and meta-analysis demonstrate that CA is characterised by pronounced, consistent RV structural and functional abnormalities. These findings provide a quantitative basis for incorporating RV parameters into multimodal echocardiographic assessment when CA is suspected and support the development of RV-specific diagnostic criteria for this condition.RV TTE Parameters in CA vs. Healthy