Right ventricular free-wall longitudinal speckle tracking strain as a prognostic criterion of adverse outcomes in patients with pulmonary hypertension: a systematic review and meta-analysis

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.