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 Károly; Friebel, Rocco; Суркова, Елена; Merkely, Béla; Kovács, Attila

doi:10.1016/j.echo.2023.01.018

Cited by 24 publications

(14 citation statements)

References 37 publications

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“…Our group has recently performed a meta-analysis in which we sought to compare the prognostic power of RV EF to conventional echocardiographic parameters (TAPSE, FWLS, FAC). We found that 1 SD reduction in RV EF was robustly associated with adverse cardiopulmonary outcomes, and importantly, RV EF had a superior predictive value compared to the other three parameters ( 17 ). Thus, 3DE-derived RV EF seems to be the best parameter among the “standard” echocardiographic metrics of RV function.…”

Section: Discussionmentioning

confidence: 77%

There is more than just longitudinal strain: Prognostic significance of biventricular circumferential mechanics

Tolvaj

Fábián

Tokodi

et al. 2023

Front. Cardiovasc. Med.

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IntroductionDespite the significant contribution of circumferential shortening to the global ventricular function, data are scarce concerning its prognostic value on long-term mortality. Accordingly, our study aimed to assess both left (LV) and right ventricular (RV) global longitudinal (GLS) and global circumferential strain (GCS) using three-dimensional echocardiography (3DE) to determine their prognostic importance.MethodsThree hundred fifty-seven patients with a wide variety of left-sided cardiac diseases were retrospectively identified (64 ± 15 years, 70% males) who underwent clinically indicated 3DE. LV and RV GLS, and GCS were quantified. To determine the prognostic power of the different patterns of biventricular mechanics, we divided the patient population into four groups. Group 1 consisted of patients with both LV GLS and RV GCS above the respective median values; Group 2 was defined as patients with LV GLS below the median while RV GCS above the median, whereas in Group 3, patients had LV GLS values above the median, while RV GCS was below median. Group 4 was defined as patients with both LV GLS and RV GCS below the median. Patients were followed up for a median of 41 months. The primary endpoint was all-cause mortality.ResultsFifty-five patients (15%) met the primary endpoint. Impaired values of both LV GCS (HR, 1.056 [95% CI, 1.027–1.085], p < 0.001) and RV GCS (1.115 [1.068–1.164], p < 0.001) were associated with increased risk of death by univariable Cox regression. Patients with both LV GLS and RV GCS below the median (Group 4) had a more than 5-fold increased risk of death compared with those in Group 1 (5.089 [2.399–10.793], p < 0.001) and more than 3.5-fold compared with those in Group 2 (3.565 [1.256–10.122], p = 0.017). Interestingly, there was no significant difference in mortality between Group 3 (with LV GLS above the median) and Group 4, but being categorized into Group 3 versus Group 1 still held a more than 3-fold risk (3.099 [1.284–7.484], p = 0.012).DiscussionThe impaired values of both LV and RV GCS are associated with long-term all-cause mortality, emphasizing the importance of assessing biventricular circumferential mechanics. Reduced RV GCS is associated with significantly increased risk of mortality even if LV GLS is preserved.

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Section: Discussionmentioning

confidence: 77%

There is more than just longitudinal strain: Prognostic significance of biventricular circumferential mechanics

Tolvaj

Fábián

Tokodi

et al. 2023

Front. Cardiovasc. Med.

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“…For example, in a meta-analysis of echocardiographic studies examining RV parameters across a wide range of cardiopulmonary conditions, head-to-head comparisons showed 3-dimensional volumetric RVEF to demonstrate stronger associations with adverse outcomes than other RV functional indices inclusive of RV strain. 14 When examining RVGLS in relation to CMR EF, whereas RVGLS has been shown to be incrementally prognostic to RVEF in some conditions, 14 the independent prognostic role of RVGLS over CMR-derived RVEF has not been shown in others. 15 In this context, it is important to note that RVGLS via feature-tracking CMR is typically derived from a single, standard 4 chamber view tailored for the LV, whereas RVEF is derived volumetrically on CMR incorporating the function of the entire RV.…”

Section: See Article By Barrett Et Almentioning

confidence: 99%

Moving Beyond Right Ventricular Ejection Fraction: Incremental Prognostic Role of Right Ventricular Strain on Postcardiac Transplant Outcomes

Owyang,

Kim

2024

Circ: Cardiovascular Imaging

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“…These findings raise the question about the role of the evaluation of RV contraction beyond the longitudinal shortening in patients with LV dysfunction, considering that identifying the decrease in other motion components could be useful as early markers or RV dysfunction, follow-up parameters or indicators for treatment escalation. Accordingly, in a meta-analysis of more than 1,900 patients, Sayour et al have elegantly demonstrated that 3D RVEF has a stronger association with adverse cardiopulmonary outcomes than conventional RV functional indices, namely TAPSE, FAC and RV FWS 30 .…”

Section: Evidence About the Clinical Utility Of The Different Compone...mentioning

confidence: 99%

Three-Dimensional Echocardiographic Evaluation of Longitudinal and Non-Longitudinal Components of Right Ventricular Contraction Results from the World Alliance of Societies of Echocardiography Study

Cotella

Kovács

Addetia

et al. 2023

Preprint

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Background: Right ventricular (RV) functional assessment is mainly limited to its longitudinal component. However, due to the complex orientation of the myofibers, the RV contraction involves coordinated motion along multiple planes. Recently developed 3-dimensional echocardiography (3DE) software has enabled the separate assessment of the non-longitudinal components of RV systolic function and their relative contribution to RV performance. The aims of this study were 1) to establish normal values for 3D-derived longitudinal, radial, and anteroposterior RV ejection fraction (LEF, REF, AEF respectively) and their relative contributions to global RVEF, 2) to calculate 3D RV strain normal values and, 3) to determine sex, age and race related differences in these parameters in a large group of normal subjects (WASE study) Methods: 1043 healthy adult subjects prospectively enrolled at 17 centers in 15 countries were used in this study. 3DE RV wide-angle datasets were analyzed to generate a 3D mesh model of the RV cavity (TomTec). Then, dedicated software (ReVISION) was used to analyze RV motion along the three main anatomical planes and the ejection fraction (EF) values corresponding to each plane were identified as LEF, REF, and AEF. Relative contributions were determined by dividing each EF component by the global RVEF. RV strain analysis included longitudinal, circumferential, and global area strains (GLS, GCS and GAS, respectively). Results were categorized by sex, age (18-40, 41-65 and >65 years), and race. Results: Absolute REF, AEF, LEF and global RVEF were higher in women than in men (p < .001). With aging, both sexes exhibited a decline in all the determinants of longitudinal shortening (p < .001). In elderly women, the lower global RVEF was partially compensated by an increase in radial shortening. Both Black men and women showed lower RVEF, and GAS values compared to White and Asian subjects of the same sex (p < .001). Black men showed significantly higher REF/RVEF and lower LEF/RVEF compared to Asian and White men. These differences in RV contraction patterns across races were not present in women. Conclusion: 3DE evaluation of the non-longitudinal components of RV contraction provides additional information regarding RV physiology, including sex, age and race - related differences in RV contraction patterns that may prove useful in disease states involving the RV.

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Association of Right Ventricular Functional Parameters With Adverse Cardiopulmonary Outcomes: A Meta-analysis

Cited by 24 publications

References 37 publications

There is more than just longitudinal strain: Prognostic significance of biventricular circumferential mechanics

There is more than just longitudinal strain: Prognostic significance of biventricular circumferential mechanics

Moving Beyond Right Ventricular Ejection Fraction: Incremental Prognostic Role of Right Ventricular Strain on Postcardiac Transplant Outcomes

Three-Dimensional Echocardiographic Evaluation of Longitudinal and Non-Longitudinal Components of Right Ventricular Contraction Results from the World Alliance of Societies of Echocardiography Study

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