August 14, 2024Open Access

Prognostic values of right ventricular echocardiography functional parameters for mortality prediction in precapillary pulmonary hypertension: a systematic review and meta-analysis

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Precapillary pulmonary hypertension (n=2171). Intervention: Right ventricular echocardiography functional parameters (e.g., TAPSE). Primary outcome: Mortality (HR 1.28, 95% CI 1.17-1.40, p=<0.001).

BLBryan Gervais de LiyisUdayana University LSLuh Oliva Saraswati SuastikaUdayana University JSJane Carissa SutedjaUdayana University

Key Result

Right ventricular echocardiographic parameters, including TAPSE (HR 1.28) and RVLS (HR 1.74), were significant prognosticators of mortality in precapillary pulmonary hypertension.

Study Design

Type

Meta-Analysis (n=2,171)

Structured PICO

Do right ventricular echocardiographic functional parameters predict mortality in patients with precapillary pulmonary hypertension?

Population

2,171 adults with precapillary pulmonary hypertension (Groups 1, 3, and 4) pooled from 24 cohort studies, mean age 51.18, 70.64% female, multinational (12 countries). Key inclusion: mean age at least 40 years, follow-up ≥6 months. Key exclusion: Group 2 and Group 5 PH, pediatric populations, prior chemotherapy, autoimmune or psychiatric conditions.

Intervention

Right ventricular echocardiographic functional parameters (TAPSE, RVSP, RVLS, RVFAC, RVEF, and RIMP) assessed using three-dimensional speckle tracking echocardiography within 1 week of diagnosing precapillary PH.

Outcome

Mortality (assessed via hazard ratios)hard clinical

Right ventricular echocardiographic parameters, specifically TAPSE, RVLS, RVFAC, RVEF, and RIMP, are significant prognostic indicators for mortality in patients with precapillary pulmonary hypertension.

Main Result

Effect estimate: HR 1.28 (95% CI 1.17-1.40)

p-value: p=<0.001

Limitations

Restricted availability of complete data from the included studies for sROC and Kaplan-Meier analyses
Absence of data pertaining to pulmonary vascular resistance (PVR) values in most studies
Majority of included studies were single-center observational retrospective, introducing potential biases
Lack of detailed patient-level data regarding NYHA and WHO functional class

Abstract

BACKGROUND: Echocardiographic prognostic indicators of precapillary pulmonary hypertension (PH) mortality has been inconclusive. This study aims to examine the prognostic values of right ventricular echocardiographic functional parameters in predicting precapillary PH mortality. METHODS: Systematic searches were conducted in the ScienceDirect, Medline, and Cochrane databases for longitudinal studies. Assessments included means and hazard ratios (HRs) for Tricuspid Annular Plane Systolic Excursion (TAPSE), Right Ventricular Systolic Pressure (RVSP), Right Ventricular Longitudinal Strain (RVLS), Right Ventricular Fractional Area Change (RVFAC), Right Ventricular Ejection Fraction (RVEF), and Right Ventricular Index of Myocardial Performance (RIMP). RESULTS: The meta-analysis included 24 cohort studies comprising 2171 participants. Mean values were as follows: TAPSE 17.62 mm, RVSP 77.50 mmHg, RVLS - 16.78%, RVFAC 29.81%, RVEF 37.56%, and RIMP 0.52. TAPSE (HR: 1.28; 95% CI 1.17-1.40; p < 0.001), RVLS (HR: 1.74; 95% CI 1.34-2.26; p < 0.001), RVFAC (HR: 1.40; 95% CI 1.13-1.75; p < 0.001), RVEF (HR: 1.08; 95% CI 1.02-1.15; p = 0.01), and RIMP (HR: 1.51; 95% CI 1.23-1.86; p < 0.001) emerged as significant prognosticators of precapillary PH mortality, with the exception of RVSP (HR: 1.04; 95% CI 0.99-1.09; p = 0.14). TAPSE summary receiver operating characteristics (sROC) analysis yielded an area under the curve (AUC) of 0.85 95% CI 0.81-0.88 with a sensitivity of 0.81 95% CI 0.63-0.91 and a specificity of 0.74 95% CI 0.54-0.87. RVLS sROC resulted in an AUC of 0.74 95% CI 0.70-0.78 with a sensitivity of 0.74 95% CI 0.57-0.86 and a specificity of 0.69 95% CI 0.64-0.75. CONCLUSIONS: TAPSE, RVLS, RVFAC, RVEF, and RIMP demonstrated promise as valuable prognostic indicators for precapillary PH mortality.

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