Department of Cardiovascular Medicine, Saga University Faculty of Medicine, Saga, Japan
University of Occupational and Environmental Health Japan, Kitakyushu, Fukuoka, Japan.
Open Heart. 2024 Feb 7;11(1):e002561. doi: 10.1136/openhrt-2023-002561.
Right ventricular (RV) dysfunction is associated with adverse outcomes in patients with pulmonary hypertension (PH). This systematic review and meta-analysis evaluated the prognostic value of RV free-wall longitudinal strain (RVfwLS), compared with other RV parameters in PH.
We searched for articles presenting the HR of two-dimensional RVfwLS in PH. HRs were standardised using the within-study SD. The ratio of HRs of a 1 SD change in RVfwLS versus systolic pulmonary arterial pressure (SPAP), systolic tricuspid annular velocities (s'-TV), RV fractional area change (FAC) or tricuspid annular plane systolic excursion (TAPSE) was calculated for each study, after which we conducted a random model meta-analysis. Subgroup analysis regarding the type of outcome, aetiology of PH and software vendor was also performed.
Twenty articles totalling 2790 subjects were included. The pooled HR of a 1 SD decrease of RVfwLS was 1.80 (95% CI: 1.62 to 2.00, p<0.001), and there was a significant association with all-cause death (ACD) and composite endpoints (CEs). The ratio of HR analysis revealed that RVfwLS has a significant, strong association with ACD and CE per 1 SD change, compared with corresponding values of SPAP, s'-TV, RVFAC or TAPSE. RVfwLS was a significant prognostic factor regardless of the aetiology of PH. However, significant superiority of RVfwLS versus other parameters was not observed in group 1 PH.
The prognostic value of RVfwLS in patients with PH was confirmed, and RVfwLS is better than other RV parameters and SPAP. Further accumulation of evidence is needed to perform a detailed subgroup analysis for each type of PH.
UMIN Clinical Trials Registry (UMIN000052679).
右心室（RV）功能障碍与肺动脉高压（PH）患者的不良预后相关。本系统评价和荟萃分析评估了 RV 游离壁纵向应变（RVfwLS）与 PH 中其他 RV 参数相比的预后价值。
我们搜索了报告 PH 中二维 RVfwLS 与 HR 的文章。使用研究内 SD 对 HR 进行标准化。对于每项研究，计算了 RVfwLS 与收缩期肺动脉压（SPAP）、收缩期三尖瓣环速度（s'-TV）、RV 分数面积变化（FAC）或三尖瓣环平面收缩期位移（TAPSE）变化 1 SD 的 HR 比值，然后进行随机模型荟萃分析。还进行了关于结局类型、PH 病因和软件供应商的亚组分析。
共纳入 20 篇文章，总计 2790 例患者。RVfwLS 降低 1 SD 的汇总 HR 为 1.80（95%CI：1.62 至 2.00，p<0.001），与全因死亡（ACD）和复合终点（CE）有显著相关性。HR 分析比值表明，与 SPAP、s'-TV、RVFAC 或 TAPSE 的相应值相比，RVfwLS 与 ACD 和 CE 每 1 SD 变化具有显著的、强相关性。无论 PH 的病因如何，RVfwLS 都是一个重要的预后因素。然而，在 1 型 PH 组中，RVfwLS 与其他参数相比没有显著优势。
在 PH 患者中，RVfwLS 的预后价值得到了证实，并且 RVfwLS 优于其他 RV 参数和 SPAP。需要进一步积累证据，以便对每种类型的 PH 进行详细的亚组分析。
UMIN 临床研究注册（UMIN000052679）。
