The absence of consensus regarding the reference values of right ventricular free wall longitudinal strain (RVFWLS) and its predictive value prompted us to conduct a systematic review and meta-analysis of publications on the predictive role of this parameter in patients with pulmonary hypertension (PH).Aim. To study the independent predictive value of RVFWLS in PH patients using 2D/3D speckle tracking echocardiography.Material and methods. Firstly, 317 publications (PubMed) and 857 Google Scholar results were selected. Of the initially identified search results, 12 articles were analyzed. The papers were cohort designed.Results. The total number of patients with PH was 1281. The mean age of patients was 54,7±6,8 years. Four studies compared the RVFWLS with a control group (n=251). The mean RVFWLS were -17,0±2,4% and -24,7±2,2% in the experimental and control groups, respectively. A meta-analysis of the difference between the mean RVFWLS values in experimental and control group patients showed its total increase in PH subjects of 8,06% (95% CI: 5,18-10,94%; p<0,00001).The total number of deaths was 268 (all-cause — 180, composite endpoint — 88). According to the meta-analysis, with an increase of 1% in RVFWLS, there is an increase in mean all-cause mortality risk by 14% (p<0,00001), as well as mean risk of adverse outcomes or PH-related events (composite endpoint) by 14% (p<0,0001).Conclusion. These results highlight the high independent predictive value of RVFWLS as a predictor of adverse outcomes or events associated with a right ventricular dysfunction progression in PH patients.

Left ventricular (LV) global function index (LVGFI) is a novel marker that incorporates the functional and structural characteristics of the LV.Aim. To evaluate the prognostic value of LVGFI in outpatients with heart failure with preserved ejection fraction (HFpEF) aged 60 years and older.Material and methods. The study included 78 patients (male, 42%) aged 74 (67-77) years with NYHA class II-III heart failure. LVGFI was defined as LV stroke volume/LV global volume х 100, where LV global volume was the sum of the LV mean cavity volume ((LV end-diastolic volume + LV end-systolic volume)/2) and myocardial volume (LV mass/ density).Results. The median LVGFI was 21,7% (interquartile range 19,3 to 22,9%). Higher NYHA class of HF was associated with worse LVGFI:class II HF was associated with LVGFI of 22,0 (20,3-23,1)%, class III HF — with 20,4 (17,5-22,4)%. During the 3—month (24-48) follow-up period, 15 (19,2%) patients died. Among patients with NYHA class II HF, 6 out of 61 (9,8%) died, with class III HF — 9 out of 17 (53,0%) (p<0,001). According to ROC analysis, the optimal LVGFI cut-off point for the prediction of an unfavorable prognosis in patients with HFpEF aged 60 years was ≤21,1% (p<0,001). The sensitivity was 73,3%, specificity — 70,0%. Patients with LVGFI ≤21,1% had significantly lower survival: among patients with LVGFI ≤21,1%, 11 out of 30 (36,7%) died; among those with LVGFI >21,1%, 4 out of 48 (8,3 %) died (p=0,016).Conclusion. Higher NYHA class of HF was associated with worse LVGFI. Patients with lower LVGFI have significantly lower survival. The optimal LVGFI cut-off point for the prediction of an unfavorable prognosis in patients with HFrEF aged 60 years was <21,1%.