Prognostic value of right ventricular longitudinal strain assessed by multimodal imaging in amyloidosis: systematic review and meta-analysis.

IF 6.6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

European Heart Journal - Cardiovascular Imaging Pub Date : 2025-09-30 DOI:10.1093/ehjci/jeaf216

Javier Herrera-Flores, Robin W M Vernooij, Arjun K Ghosh, Ashutosh Wechalekar, Richard K Cheng, Kalliopi Keramida, Manuel Anguita, Pedro L Sanchez, Candelas Perez Del Villar, Cristian Herrera-Flores

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Abstract

Aims: 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.

Methods and results: 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 1772 patients [mean age 68.8 ± 8.8 years; 57.3% with light-chain amyloidosis (AL)], were analysed. 210 patients experienced the composite outcome (median [inter-quartile 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%).

Conclusion: RV longitudinal strain parameters are powerful and robust predictors of adverse outcomes in amyloidosis.

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多模态成像评估淀粉样变性患者右心室纵向应变的预后价值：系统回顾和荟萃分析。

目的：淀粉样变性是一种进行性且经常致命的疾病，右室（RV）受累是预后的关键决定因素。本荟萃分析旨在评估右心室纵向应变参数在淀粉样变性患者中的预后意义。方法和结果：纳入了通过超声心动图或心脏磁共振（CMR）评估的右心室自由壁纵向应变（RV- fwls）和右心室整体纵向应变（RV- gls）与不良结局之间关联的合格研究。采用反向加权随机效应荟萃分析，计算全因死亡率和全因死亡或心力衰竭住院治疗的综合终点（每降低1% RV应变值）的合并风险比（hr）和95%置信区间（ci）。18项低至中等偏倚风险的研究（纽卡斯尔-渥太华量表），包括1772例患者(平均年龄68.8±8.8岁；57.3%为轻链淀粉样变性[AL])。210例患者出现了复合结果（中位[四分位数范围]随访：1.5[0.6]年），628例患者死亡（中位随访：2.6[1.6]年）。2D斑点追踪RV-FWLS与全因死亡率相关(HR: 1.10；95%置信区间:1.07—-1.13;I²= 8.6%)和综合结局(HR: 1.06；95%置信区间:1.02—-1.10;I²= 0%)。同样，2D斑点跟踪RV-GLS与全因死亡率相关(HR: 1.10；95%置信区间:1.07—-1.13;I²= 8.6%)。亚组和荟萃回归分析证实了淀粉样蛋白亚型、研究设计、心脏受累、随访时间和应变分析软件之间的一致性。在AL淀粉样变中，基于cmr的RV-GLS也能预测全因死亡率(HR: 1.06；95%置信区间:1.03—-1.09;I²= 0%)。结论：右心室纵向应变参数是淀粉样变不良结局的有力预测因子。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Heart Journal - Cardiovascular Imaging CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

9.70%

发文量

708

审稿时长

4-8 weeks

期刊介绍： European Heart Journal – Cardiovascular Imaging is a monthly international peer reviewed journal dealing with Cardiovascular Imaging. It is an official publication of the European Association of Cardiovascular Imaging, a branch of the European Society of Cardiology. The journal aims to publish the highest quality material, both scientific and clinical from all areas of cardiovascular imaging including echocardiography, magnetic resonance, computed tomography, nuclear and invasive imaging. A range of article types will be considered, including original research, reviews, editorials, image focus, letters and recommendation papers from relevant groups of the European Society of Cardiology. In addition it provides a forum for the exchange of information on all aspects of cardiovascular imaging.