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

Alex Ali Sayour; Márton Tokodi; Csilla Celeng; Richard A P Takx; Alexandra Fábián; Bálint K Lakatos; Rocco Friebel; Elena Surkova; Béla Merkely; Attila Kovács

doi:10.1016/j.echo.2023.01.018

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

J Am Soc Echocardiogr. 2023 Jun;36(6):624-633.e8. doi: 10.1016/j.echo.2023.01.018. Epub 2023 Feb 10.

Authors

Affiliations

¹ Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
² Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
³ Department of Radiology, Amsterdam UMC, Amsterdam, The Netherlands.
⁴ Department of Health Policy, London School of Economics and Political Science, London, United Kingdom.
⁵ Harefield Hospital, Royal Brompton and Harefield Hospitals, Part of Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
⁶ Heart and Vascular Center, Semmelweis University, Budapest, Hungary. Electronic address: attila.kovacs@med.semmelweis-univ.hu.

PMID: 36773817
DOI: 10.1016/j.echo.2023.01.018

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: I² = 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.

Keywords: 3D echocardiography; Heart failure; Right ventricular dysfunction.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Echocardiography / methods
Echocardiography, Three-Dimensional*
Heart Ventricles / diagnostic imaging
Humans
Stroke Volume
Ventricular Dysfunction, Right* / diagnostic imaging
Ventricular Function, Right