Association of right ventricular functional parameters with adverse cardiopulmonary outcomes - a meta-analysis

Sayour, Alex Ali, Tokodi, Márton, Celeng, Csilla, Takx, Richard A.p., Fábián, Alexandra, Lakatos, Bálint K., Friebel, Rocco ORCID: 0000-0003-1256-9096, Surkova, Elena, Merkely, Béla and Kovács, Attila (2023) Association of right ventricular functional parameters with adverse cardiopulmonary outcomes - a meta-analysis. Journal of the American Society of Echocardiography, 36 (6). 624 - 633.e8. ISSN 0894-7317

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Abstract

Aims: We aimed to confirm that three-dimensional echocardiography–derived right ventricular ejection fraction (RVEF) is better associated with adverse cardiopulmonary outcomes than the conventional echocardiographic parameters. Methods: We performed a meta-analysis of studies reporting the impact of unit change of RVEF, tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and free-wall longitudinal strain (FWLS) on clinical outcomes (all-cause mortality and/or adverse cardiopulmonary outcomes). Hazard ratios (HRs) were rescaled by the within-study SDs to represent standardized changes. Within each study, we calculated the ratio of HRs related to a 1 SD reduction in RVEF versus TAPSE, or FAC, or FWLS, to quantify the association of RVEF with adverse outcomes relative to the other metrics. These ratios of HRs were pooled using random-effects models. Results: Ten independent studies were identified as suitable, including data on 1,928 patients with various cardiopulmonary conditions. Overall, a 1 SD reduction in RVEF was robustly associated with adverse outcomes (HR = 2.64 [95% CI, 2.18-3.20], P < .001; heterogeneity: I 2 = 65%, P = .002). In studies reporting HRs for RVEF and TAPSE, or RVEF and FAC, or RVEF and FWLS in the same cohort, head-to-head comparison revealed that RVEF showed significantly stronger association with adverse outcomes per SD reduction versus the other 3 parameters (vs TAPSE, HR = 1.54 [95% CI, 1.04-2.28], P = .031; vs FAC, HR = 1.45 [95% CI, 1.15-1.81], P = .001; vs FWLS, HR = 1.44 [95% CI, 1.07-1.95], P = .018). Conclusion: Reduction in three-dimensional echocardiography–derived RVEF shows stronger association with adverse clinical outcomes than conventional right ventricular functional indices; therefore, it might further refine the risk stratification of patients with cardiopulmonary diseases.

Item Type:	Article
Official URL:	https://www.sciencedirect.com/journal/journal-of-t...
Additional Information:	© 2023 The Authors
Divisions:	Health Policy
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Date Deposited:	15 Feb 2023 16:00
Last Modified:	18 Nov 2024 17:03
URI:	http://eprints.lse.ac.uk/id/eprint/118182

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