Herrera Flores Javier, Vernooij Robin W M, Ghosh Arjun K, Wechalekar Ashutosh, Cheng Richard K, Keramida Kalliopi, Anguita Manuel, Sanchez Pedro L, Del Villar Candelas Perez, Herrera Flores Cristian
Department of Cardiology. University Hospital Reina Sofia. Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC). Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV). Cordoba, Spain.
Department of Nephrology and Hypertension, University Medical Centre Utrecht.
Eur Heart J Cardiovasc Imaging. 2025 Jul 25. doi: 10.1093/ehjci/jeaf216.
Amyloidosis is a progressive and often fatal disease, with right ventricular (RV) involvement emerging as critical determinant of outcomes. This meta-analysis sought to evaluate the prognostic significance of RV longitudinal strain parameters in patients with amyloidosis.
Eligible studies reporting on the association between RV free-wall longitudinal strain (RV-FWLS) and RV global longitudinal strain (RV-GLS) assessed by echocardiography or cardiac magnetic resonance (CMR) with adverse outcomes were included. Using an inversely weighted random effects meta-analysis, pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated for all-cause mortality and a composite endpoint of all-cause death or heart failure hospitalization per 1% lower RV strain values. Eighteen studies with low-to-moderate risk of bias (Newcastle-Ottawa Scale) and encompassing 1,772 patients (mean age 68.8±8.8 years; 57.3% with light-chain amyloidosis [AL]), were analysed. 210 patients experienced the composite outcome (median [interquartile range] follow-up: 1.5 [0.6] years) and 628 died (median follow-up: 2.6 [1.6] years). 2D speckle-tracking RV-FWLS was associated with all-cause mortality (HR: 1.10; 95%CI: 1.07-1.13; I² = 8.6%) and the composite outcome (HR: 1.06; 95%CI: 1.02-1.10; I² = 0%). Similarly, 2D speckle-tracking RV-GLS was associated with all-cause mortality (HR: 1.10; 95%CI: 1.07-1.13; I² = 8.6%). Subgroup and meta-regression analysis confirmed consistency across amyloid subtypes, study design, presence of cardiac involvement, follow-up duration and strain analysis software. In AL amyloidosis, CMR-based RV-GLS also predicted all-cause mortality (HR: 1.06; 95%CI: 1.03-1.09; I² = 0%).
RV longitudinal strain parameters are powerful and robust predictors of adverse outcomes in amyloidosis.
淀粉样变性是一种进行性且通常致命的疾病，右心室（RV）受累是预后的关键决定因素。本荟萃分析旨在评估淀粉样变性患者右心室纵向应变参数的预后意义。
纳入了符合条件的研究，这些研究报告了通过超声心动图或心脏磁共振（CMR）评估的右心室游离壁纵向应变（RV-FWLS）和右心室整体纵向应变（RV-GLS）与不良结局之间的关联。使用逆加权随机效应荟萃分析，计算每降低1%右心室应变值时全因死亡率和全因死亡或心力衰竭住院复合终点的合并风险比（HRs）及95%置信区间（CIs）。对18项偏倚风险低至中度（纽卡斯尔-渥太华量表）且涵盖1772例患者（平均年龄68.8±8.8岁；57.3%为轻链淀粉样变性[AL]）的研究进行了分析。210例患者出现复合结局（中位[四分位间距]随访时间：1.5[0.6]年），628例死亡（中位随访时间：2.6[1.6]年）。二维斑点追踪RV-FWLS与全因死亡率（HR：1.10；95%CI：1.07-1.13；I² = 8.6%）和复合结局（HR：1.06；95%CI：1.02-1.10；I² = 0%）相关。同样，二维斑点追踪RV-GLS与全因死亡率（HR：1.10；95%CI：1.07-1.13；I² = 8.6%）相关。亚组和荟萃回归分析证实了在淀粉样变性亚型、研究设计、心脏受累情况、随访持续时间和应变分析软件方面的一致性。在AL淀粉样变性中，基于CMR的RV-GLS也可预测全因死亡率（HR：1.06；95%CI：1.03-1.09；I² = 0%）。
右心室纵向应变参数是淀粉样变性不良结局的有力且可靠的预测指标。
