A 1 SD decrease in right ventricular free-wall longitudinal strain was significantly associated with adverse outcomes in pulmonary hypertension (HR 1.80; 95% CI 1.62-2.00; p<0.001).
Meta-Analysis (n=2,790)
Does right ventricular free-wall longitudinal strain (RVfwLS) improve prognostic assessment compared to other right ventricular parameters in patients with pulmonary hypertension?
Right ventricular free-wall longitudinal strain is a strong prognostic factor in patients with pulmonary hypertension and provides superior prognostic value compared to conventional right ventricular parameters.
Effect estimate: HR 1.80 (95% CI 1.62-2.00)
p-value: p=<0.001
BACKGROUND: Right ventricular (RV) dysfunction is associated with adverse outcomes in patients with pulmonary hypertension (PH). This systematic review and meta-analysis evaluated the prognostic value of RV free-wall longitudinal strain (RVfwLS), compared with other RV parameters in PH. METHODS: We searched for articles presenting the HR of two-dimensional RVfwLS in PH. HRs were standardised using the within-study SD. The ratio of HRs of a 1 SD change in RVfwLS versus systolic pulmonary arterial pressure (SPAP), systolic tricuspid annular velocities (s'-TV), RV fractional area change (FAC) or tricuspid annular plane systolic excursion (TAPSE) was calculated for each study, after which we conducted a random model meta-analysis. Subgroup analysis regarding the type of outcome, aetiology of PH and software vendor was also performed. RESULTS: Twenty articles totalling 2790 subjects were included. The pooled HR of a 1 SD decrease of RVfwLS was 1.80 (95% CI: 1.62 to 2.00, p<0.001), and there was a significant association with all-cause death (ACD) and composite endpoints (CEs). The ratio of HR analysis revealed that RVfwLS has a significant, strong association with ACD and CE per 1 SD change, compared with corresponding values of SPAP, s'-TV, RVFAC or TAPSE. RVfwLS was a significant prognostic factor regardless of the aetiology of PH. However, significant superiority of RVfwLS versus other parameters was not observed in group 1 PH. CONCLUSIONS: The prognostic value of RVfwLS in patients with PH was confirmed, and RVfwLS is better than other RV parameters and SPAP. Further accumulation of evidence is needed to perform a detailed subgroup analysis for each type of PH. TRIAL REGISTRATION NUMBER: UMIN Clinical Trials Registry (UMIN000052679).
Nabeshima et al. (Thu,) conducted a meta-analysis in Pulmonary hypertension (n=2,790). Right ventricular free-wall longitudinal strain (RVfwLS) vs. Systolic pulmonary arterial pressure (SPAP), s'-TV, RVFAC, or TAPSE was evaluated on All-cause death and composite endpoints (HR 1.80, 95% CI 1.62-2.00, p=<0.001). A 1 SD decrease in right ventricular free-wall longitudinal strain was significantly associated with adverse outcomes in pulmonary hypertension (HR 1.80; 95% CI 1.62-2.00; p<0.001).