Prognostic value of right ventricular longitudinal strain assessed by multimodal imaging in amyloidosis: systematic review and meta-analysis Free
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Authors
Herrera-Flores, Javier
Vernooij, Robin W. M.
Ghosh, Arjun K.
Wechalekar, Ashutosh
Cheng, Richard K.
Keramida, Kalliopi
Anguita, Manuel
Sanchez, Pedro L.
Villar, Candelas Perez del
Herrera-Flores, Cristian
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Issue Date
2025
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Article
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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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European Heart Journal - Cardiovascular Imaging
Volume
26
Issue
10