Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Phililps van Leijdenlaan 15, EX Nijmegen, The Netherlands.
Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, 3 Byrom Street, Liverpool, UK.
Eur Heart J Cardiovasc Imaging. 2019 Apr 1;20(4):475-484. doi: 10.1093/ehjci/jey120.
Pulmonary hypertension (PH) is associated with high morbidity and mortality and the predictive capacity of traditional functional echocardiographic measures is poor. Recent studies assessed the predictive capacity of right ventricular longitudinal strain (RVLS). Diversity in methods between these studies resulted in conflicting outcomes. The purpose of this systematic review and meta-analysis was to determine the independent prognostic value of RVLS for PH-related events and all-cause mortality.
A systematic search in Pubmed (MEDLINE), Embase, the Cochrane Library, and Web of Science was performed to identify studies that examined the prognostic value of RVLS in patients with PH. Studies reporting Cox regression based hazard ratios (HRs) for a combined endpoint of mortality and PH-related events or all-cause mortality for echocardiographic derived RVLS were included. A weighted mean of the multivariate HR was used to determine the independent predictive value of RVLS. Eleven studies met our criteria, including 1169 patients with PH (67% female, 0.6-3.8 years follow-up). PH patients with a relative reduction of RVLS of 19% had a significantly higher risk for the combined endpoint [HR 1.22, 95% confidence interval (CI) 1.07-1.40], while patients with a relative reduction of RVLS of 22% had a significantly higher risk for all-cause mortality (HR 2.96, 95% CI 2.00-4.38).
This systematic review and meta-analysis showed that RVLS has independent prognostic value for a combined endpoint and all-cause mortality in patients with PH. Collectively, these findings emphasize that RVLS may have value for optimizing current predictive models for clinical events or mortality in patients with PH.
肺动脉高压（PH）与高发病率和死亡率相关，传统的功能超声心动图测量的预测能力较差。最近的研究评估了右心室纵向应变（RVLS）的预测能力。这些研究之间方法的多样性导致了结果的冲突。本系统评价和荟萃分析的目的是确定 RVLS 对 PH 相关事件和全因死亡率的独立预后价值。
在 Pubmed（MEDLINE）、Embase、Cochrane 图书馆和 Web of Science 中进行了系统检索，以确定研究 RVLS 在 PH 患者中的预后价值。纳入报告 Cox 回归基于超声心动图衍生 RVLS 的死亡率和 PH 相关事件或全因死亡率综合终点的危险比（HR）的研究。使用多元 HR 的加权平均值来确定 RVLS 的独立预测价值。符合标准的 11 项研究包括 1169 例 PH 患者（67%为女性，0.6-3.8 年随访）。RVLS 相对减少 19%的 PH 患者发生综合终点的风险显著增加[HR 1.22，95%置信区间（CI）1.07-1.40]，而 RVLS 相对减少 22%的患者发生全因死亡率的风险显著增加（HR 2.96，95%CI 2.00-4.38）。
本系统评价和荟萃分析表明，RVLS 对 PH 患者的综合终点和全因死亡率具有独立的预后价值。总的来说，这些发现强调了 RVLS 可能对优化当前 PH 患者临床事件或死亡率的预测模型具有价值。
