The prognostic value of right ventricular longitudinal strain in heart failure: a systematic review and meta-analysis

Abstract

Background: Right ventricular (RV) dysfunction is a well-recognized adverse prognostic feature in patients with heart failure (HF). Recently, many single-center studies have demonstrated that RV longitudinal strain assessed using speckle tracking echocardiography might be a powerful prognosticator in HF. Objectives: To systematically appraise and quantitatively synthesize the evidence of the prognostic value of echocardiographic RV longitudinal strain, across the entire spectrum of left ventricular ejection function (LVEF) in HF. Methods: A systematic literature review was conducted in electronic databases to identify every study reporting the predictive role of RV global longitudinal strain (RV GLS) and RV free wall longitudinal strain (RV FWLS) in HF subjects. A random-effects meta-analysis was conducted to quantify the adjusted and unadjusted hazard ratios [(a)HRs] for all-cause-mortality and for the composite outcome of all-cause mortality or HF-related hospitalization for both indices. Results: Twenty-four studies were deemed eligible and 15 of these provided appropriate quantitative data for the meta-analysis, encompassing 8,738 patients. Each 1% worsening in RV GLS and RV FWLS was independently associated with increased risk of all-cause mortality (pooled aHR = 1.08 [1.03–1.13]; p < 0.01; I2 = 76% and 1.05 [1.05–1.06]; p < 0.01; I2 = 0%, respectively) and the composite outcome (pooled aHR = 1.10 [1.06–1.15]; p < 0.01; I2 = 0% and 1.06 [1.02–1.10]; p < 0.01; I2 = 69%, respectively) for patients with HF. The subgroup analysis of HF patients with LVEF < 45% yielded similar results, with worsening in RV GLS and RV FWLS retaining strong association with the two outcomes. Conclusion: Echocardiographic RV GLS and RV FWLS appear to have powerful prognostic value across the range of HF.

Improvement in Left and Right Ventricular Function after Introduction of SGLT2 Inhibitors in Heart Failure Outpatients with Reduced Ejection Fraction

“…In particular, in recent years, longitudinal strain analysis has demonstrated greater sensitivity in detecting early myocardial dysfunction compared to traditional echocardiographic parameters [26]. Moreover, this analysis has shown enhanced accuracy in stratifying the prognosis of heart failure patients by assessing both LV and RV systolic function [27,28]. Furthermore, the semi-automatic analysis of 2D-ST that we employed is less influenced by operators [26], ensuring greater objectivity and reliability in our findings.…”

The Prognostic Value of Right Ventricular Function in Patients with Chronic Heart Failure—A Prospective Study

“…Other echocardiographic parameters have proven to be more significant in predicting the clinical outcomes of patients with heart failure, such as myocardial deformation imaging and parameters of right ventricular (RV) function [7,[9][10][11]. However, studies on this topic mainly report on preselected cohorts, e.g., only including patients in sinus rhythm or excluding patients with chronic kidney disease or other relevant comorbidities in heart failure [12].…”

Right Ventricular Function in Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia: From the CTOXALL Study

“…Although RV function has been shown to be strongly associated with outcomes in multiple cardiac conditions, its quantification traditionally poses challenges because of the complex geometry and physiology of the RV [9]. Recently, right ventricle strain (RVS) has been proposed as a straightforward and robust measure of right ventricular function [10]. Importantly, RVS is angle-independent and has a stronger correlation with cardiac magnetic resonance-based RV ejection fraction than conventional echocardiographic indices [11].…”