Landzaat Jochem W D, van Heerebeek Loek, Jonkman Nini H, van der Bijl Esther M, Riezebos Robert K
Department of Cardiology, From the Heart Center, Division Cardiology of the OLVG Hospital, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.
Department of Research and Epidemiology, OLVG Hospital, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.
J Echocardiogr. 2023 Mar;21(1):1-15. doi: 10.1007/s12574-022-00592-7. Epub 2022 Oct 25.
Right ventricular function is strongly associated with clinical outcomes in many conditions, and the evaluation of right ventricle (RV) structure and function in patients with cardiopulmonary disorders is an essential component of clinical management. The objective of this study was to determine the normal ranges of right ventricular longitudinal strain (RVLS) measurements derived by two-dimensional (2D) speckle tracking echocardiography (STE) through a systematic review and meta-analysis. A systematic review was performed using PubMed, Cochrane, ClinicalKey, and CINAHL. Search terms covered the concepts of right ventricle, strain, speckle-tracking, and 2D echocardiography with additional filtering for humans and adults over the last decade. The RV four-chamber longitudinal strain (RV4CLS), RV free wall longitudinal strain (RVFWLS), and free wall longitudinal segmental strain values of healthy individuals without cardiopulmonary diseases from 28 studies were assessed. Weighted means were estimated using random-effects models in a meta-analysis. The results show for RV4CLS -24,91%[CI - 25.94; - 23.88, I 98%], for RVFWLS -27.63%[CI - 28.78; - 26.48, I 98%], for basal RVFWLS -26.65%[CI - 30.57; - 22.73, I 99%], mid RVFWLS -27.61%[CI - 30.99; - 24.22, I 99%] and apical RVFWLS -24.54%[CI - 26.70; - 22.38, I 98%]. This systematic review and meta-analysis showed longitudinal strain values of 2D STE derived RV. No clear reference value for RV strain can be distilled from the literature search due to high statistical heterogeneity between the studies. However, all results of our analysis suggest that the lower reference values for RVLS in the current recommendations with a cut-off value of - 20% is underestimated.
右心室功能在许多情况下与临床结局密切相关，评估心肺疾病患者的右心室（RV）结构和功能是临床管理的重要组成部分。本研究的目的是通过系统评价和荟萃分析确定二维（2D）斑点追踪超声心动图（STE）得出的右心室纵向应变（RVLS）测量值的正常范围。使用PubMed、Cochrane、ClinicalKey和CINAHL进行系统评价。检索词涵盖右心室、应变、斑点追踪和2D超声心动图的概念，并对过去十年的人类和成年人进行了额外筛选。评估了28项研究中无心肺疾病的健康个体的右心室四腔纵向应变（RV4CLS）、右心室游离壁纵向应变（RVFWLS）和游离壁纵向节段应变值。在荟萃分析中使用随机效应模型估计加权均值。结果显示，RV4CLS为-24.91%[可信区间（CI）-25.94；-23.88，I² 98%]，RVFWLS为-27.63%[CI -28.78；-26.48，I² 98%]，基底RVFWLS为-26.65%[CI -30.57；-22.73，I² 99%]，中间RVFWLS为-27.61%[CI -30.99；-24.22，I² 99%]，心尖RVFWLS为-24.54%[CI -26.70；-22.38，I² 98%]。这项系统评价和荟萃分析显示了2D STE得出的RV纵向应变值。由于各研究之间存在高度统计学异质性，因此无法从文献检索中提炼出明确的RV应变参考值。然而，我们分析的所有结果表明，当前建议中RVLS的较低参考值（截止值为-20%）被低估了。
