Use of Speckle Tracking Echocardiography to Predict Right Heart Failure Following Left Ventricular Assist Device Implantation: A Systematic Review and Meta-Analysis

Use of Speckle Tracking Echocardiography to Predict Right Heart Failure Following Left Ventricular Assist Device Implantation: A Systematic Review and Meta-Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Use of Speckle Tracking Echocardiography to Predict Right Heart Failure Following Left Ventricular Assist Device Implantation: A Systematic Review and Meta-Analysis Jesse Frye, Michael Tao, Simrat Dhaliwal, Edlira Tam, Marc Goldschmidt, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4046496/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction Right Heart Failure (RHF) is an important consequence of implant of left ventricular assist devices (LVAD). Right ventricular (RV) analysis with speckle tracking echo (STE) can assist in the assessment of the RV. This meta-analysis examines preoperative RV strain on STE as a predictor of postoperative RHF. Methods Literature was reviewed in Pubmed, EMBASE, and Web of Science for studies reporting on the association of preoperative RV free wall (FWS), global longitudinal (GLS), and septal longitudinal (SLS) strain with postoperative RV failure following LVAD placement. Strain parameters were compared between the two groups. Results A total of 13 studies with 933 patients undergoing LVAD implantation met inclusion criteria. 254 patients subsequently developed RHF and 679 did not develop RHF. Mean follow up was 15 months. The mean age of participants was 55.9 years and 85% were male. Baseline RVFWS, RVGLS, and RVSLS were significantly reduced in patients who developed post-implantation RHF compared to patients who did not develop post-implantation RHF (MD 3.77, 95% CI 2.39, 5.15; p<0.01; MD 2.67, 95% CI 1.16, 4.17; p<0.01; MD 3.59, 95% CI 0.83, 6.35; p=0.01). The heterogeneity was considerable for all three analyses (RVFWS I2=88%, RVGLS I2=92%, RVSLS I2=83%), likely due to vendor-specific differences in strain measurements and differences in echocardiography lab protocols. To address this, a random-effects model was used. Conclusions Preoperative RV FWS, GLS, and SLS were all associated with postoperative RHF. STE may be helpful in risk stratification of RHF following LVAD implant. Speckle tracking echocardiography LVAD right heart failure Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Heart Failure (HF) continues to pose a global health and financial challenge, affecting over 23 million individuals worldwide and is responsible for a large proportion of hospitalizations for individuals 65 and older [1, 2]. The disease is progressive, incurable, and prognosis is poor, especially when someone’s clinical condition is refractory to pharmacologic therapy. Since the 1990s, heart transplant (HT) gained popularity as a potential treatment in end-stage HF [3]. Soon after, the advent of temporary MCS via LVAD followed to allow for bridge-to-transplant. However, HT has its limitations, especially when faced with limited organ availability [4]. The REMATCH (Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure) trial in 2001 demonstrated groundbreaking potential for LVADs as destination therapy for end-stage HF patients[5]. Now nearly 50% of LVAD use constitutes destination therapy [6]. The outcome of patients treated with LVADs is in part determined by post implantation RV function. RHF occurs in 20-40% of patients post-LVAD and is subsequently associated with worse outcomes, and greater morality rates [7, 8]. The etiology of RHF is multifactorial, ranging from increased preload stress, to the unsupported right ventricle (RV), to worsening pre-existing tricuspid regurgitation [9-11]. Worsening of pre-existing undiagnosed RV dysfunction is also a potential contributor that has not been well studied, and the incidence of it is unknown. Thus, pre-implant assessment of the RV is crucial and standard of care [12]. Traditionally, transthoracic echocardiogram (TTE) has been used to assess RV function to prognosticate RHF in pre-LVAD implant patients. However traditional TTE parameters, such as tricuspid annular planar systolic excursion and fractional area change, poorly predict RHF [13]. Speckle-tracking echocardiography (STE) may provide a potential diagnostic tool by providing information on myocardial deformation via RV strain. Strain values can be derived in several parameters: global longitudinal strain (GLS), free wall strain (FWS), and septal longitudinal strain (SLS). STE has been utilized as a prognostic tool in other cardiac pathologies, however, data on the use of STE to predict RHF post-LVAD implant patients is limited [14, 15]; thus seeks to summarize the evidence regarding the prognostic role of RV strain imaging in patients pre-LVAD in predicting RV failure. Methods Study Selection and Data Collection A review of the literature was performed in the following databases: Pubmed, EMBASE, and Web of Science. The goal was to find studies analyzing the relationship between preoperative right heart strain parameters and RV failure following LVAD placement. The primary endpoint was postoperative RV failure. RV failure included the need for salvage RVAD, prolonged inotropic support, or prolonged pulmonary vasodilator therapy. The following keywords were used: “LVAD,” “ventricular assist device,” “strain,” “right ventricular strain.” The full text of each study was manually reviewed to ensure its data was relevant to the study endpoint. A study was selected if it included patients undergoing LVAD implantation, comparing RV strain parameters (free wall strain, global longitudinal strain, septal longitudinal strain) in those who had postoperative RHF versus those who did not have postoperative RHF. Data was separately collected by two reviewers (JF and MT). The following data was collected: Lead author, year of publication, study design, follow up, age, gender, RHF, strain parameters, comorbidities, and INTERMACS class. Statistical Analysis The program “Comprehensive Meta-Analysis software, version 3.6” was utilized for the statistical aspect of the meta-analysis. A random-effects model was used to analyze the association between RV strain and RV failure. Data was analyzed in the form of an Odds-Ratio. Heterogeneity was calculated with an I2, and the data was said to be statistically significant if the p-value was < 0.05 in a two-test. Results We found 582 records through our initial screen. Of them, 13 studies met inclusion criteria for the meta-analysis (Figure 1). There was a total of 933 patients included, 254 with RV failure and 679 without RV failure. The average age was 55.9, the average follow-up was 15 months, and 85% were male. 821 patients had RV FWS imaging, 787 patients had RV GLS imaging, and 208 patients had RV SLS imaging. Baseline RVFWS, RVGLS, and RVSLS were all significantly reduced in patients who had postoperative RV failure when compared to patients who did not have postoperative RV failure. (MD 3.77, 95% CI 2.39, 5.15; p<0.01; MD 2.67, 95% CI 1.16, 4.17; p<0.01; MD 3.59, 95% CI 0.83, 6.35; p=0.01) (Figure 2, Figure 3, Figure 4). The effect size was largest for RVFWS compared to RVGLS and RVSLS (Z=5.35, Z=3.47, Z=2.55 respectively). All three analyses had significant heterogeneity (RVFWS I2=88%, RVGLS I2=92%, RVSLS I2=83%), likely due to vendor-specific differences in strain measurements and echo lab protocols. We used a random-effects model to address this. Discussion This meta-analysis evaluated the role of strain imaging performed before LVAD implant to risk stratify patients for the development of postoperative RV failure. The main findings were as follows: (a) baseline RVFWS, RVGLS, and RVSLS were all significantly reduced in patients who subsequently developed post-implantation RHF compared to patients who did not develop this outcome; (b) the effect size was largest for RVFWS compared to RVGLS and RVSLS. RHF is the leading cause of mortality post-implantation of an LVAD. Although various mechanisms proposed for development of RV dysfunction post implant, it is possible that in some patients, subclinical RV dysfunction was present before LVAD implantation, and due to increased preload, deteriorated to a point that overt dysfunction developed. Traditionally, TTE has been extensively used pre-LVAD implantation for risk assessment of developing post-implantation RHF. However, TTE parameters exhibit limited sensitivity in predicting adverse cardiovascular outcomes, primarily due to their reliance on geometric assumptions [13]. While cardiac magnetic resonance imaging, along with various risk scores, could offer more sensitive assessment, the higher cost associated with it, making this approach less desirable as a routine screening approach, TTE with the addition of Speckle-Tracking Echocardiography (STE) offer more cost-effective and automated user-independent alternatives. Notably, STE generated RVGLS and RVFWS have shown superior accuracy in assessing RV function compared to other measures, such as FAC and TAPSE[16, 17]. The RV is mainly composed of longitudinal fibers, and these fibers, located within the subendocardial layer, allow for systolic shortening [18]. STE strain assesses the degree of ventricular contraction in this longitudinal direction via GLS, SLS and FWS. A decrease in baseline longitudinal strain may indicate underlying subclinical inflammation and fibrosis affecting the subendocardial layer, leading to ventricular remodeling and eventual post-implantation RHF. Consequently, the association between reduced RVGLS, RVSLS, and RVFWS and an elevated risk for post-implantation RHF is not surprising. When comparing the various strain parameters, our results reveal that RVFWS is associated with the greatest effect size. Two prior studies, Cameli et al. and Carluccio et al., demonstrated that RVFWS appears to hold the greatest accuracy for predicting RV dysfunction, mainly because it is less influenced by LV dysfunction [19, 20]. RVGLS, although more reproducible when assessing RV dysfunction than RVFWS [21], assess also the interventricular septum in its analysis, therefore less specific for RV dysfunction. In summary, STE offers a distinct advantage over conventional TTE in evaluation RV function. The incorporation of multiple RV strain parameters enhances the potential for precise and replicable prognostication of post-implantation RHF. Conclusion Our study suggests that STE with strain analysis could help risk stratify pre-LVAD patients for the development of post-implantation RHF. As this tool is now readily available on clinically used echo machines, and artificial intelligent as well as deep machine learning allow for automated acquisition and interpretation of the data, incorporating STE into pre LVAD assessment may become the routine practice. Limitations: Our study has several limitations. Firstly, the exclusion of subjects with specific comorbidities in the studies cited may reduce the general applicability of our findings to the broader population. Furthermore, there was notable heterogeneity, likely stemming from vendor-specific variations in strain measurements and STE lab protocols. To address this issue, a random-effects model may be beneficial. While our study focuses on RHF, further high-quality research is essential to clarify the association of reduced strain measurements with other cardiovascular outcomes in LVAD patients. Lastly, it is unknown whether identifying patients at risk for developing RHF could improve their outcome, and research to assess it is essential. Abbreviations FAC: fractional area change FWS: free wall strain GLS: global longitudinal strain HF: heart failure HT: heart transplant LVADs: left ventricular assist devices LVEF: left ventricular ejection fraction MCS: mechanical circulatory support RHF: right heart failure RV: right ventricle SLS: strain of a line segment STE: speckle-tracking echocardiography TAPSE: tricuspid annular plane systolic excursion TTE: transthoracic echocardiogram Declarations Data Availability Statement: The data underlying this article will be shared on reasonable request to the corresponding author. Financial Disclosures: None Conflicts of Interest: None References Bui, A.L., T.B. Horwich, and G.C. Fonarow, Epidemiology and risk profile of heart failure. Nature Reviews Cardiology, 2011. 8 (1): p. 30-41. Roger, V.L., et al., Trends in heart failure incidence and survival in a community-based population. Jama, 2004. 292 (3): p. 344-350. Ahmed, T. and A. Jain, Heart Transplantation , in StatPearls . 2023, StatPearls Publishing Copyright © 2023, StatPearls Publishing LLC.: Treasure Island (FL) ineligible companies. Disclosure: Ankit Jain declares no relevant financial relationships with ineligible companies. Schwarz, E.R., et al., Maximal care considerations when treating patients with end-stage heart failure: ethical and procedural quandaries in management of the very sick. Journal of religion and health, 2011. 50 : p. 872-879. Rose, E.A., et al., Long-term use of a left ventricular assist device for end-stage heart failure. New England Journal of Medicine, 2001. 345 (20): p. 1435-1443. Kirklin, J.K., et al., Eighth annual INTERMACS report: special focus on framing the impact of adverse events. The Journal of Heart and Lung Transplantation, 2017. 36 (10): p. 1080-1086. Dang, N.C., et al., Right heart failure after left ventricular assist device implantation in patients with chronic congestive heart failure. The Journal of heart and lung transplantation, 2006. 25 (1): p. 1-6. Kormos, R.L., et al., Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: incidence, risk factors, and effect on outcomes. The Journal of thoracic and cardiovascular surgery, 2010. 139 (5): p. 1316-1324. Farrar, D.J., et al., Right heart interaction with the mechanically assisted left heart. World journal of surgery, 1985. 9 : p. 89-102. Morgan, J.A., et al., Impact of continuous-flow left ventricular assist device support on right ventricular function. The Journal of Heart and Lung Transplantation, 2013. 32 (4): p. 398-403. Liang, L.W., et al., Right Ventricular Global Longitudinal Strain as a Predictor of Acute and Early Right Heart Failure Post Left Ventricular Assist Device Implantation. Asaio j, 2022. 68 (3): p. 333-339. Peura, J.L., et al., Recommendations for the use of mechanical circulatory support: device strategies and patient selection: a scientific statement from the American Heart Association. Circulation, 2012. 126 (22): p. 2648-2667. Raina, A., et al., Postoperative right ventricular failure after left ventricular assist device placement is predicted by preoperative echocardiographic structural, hemodynamic, and functional parameters. Journal of cardiac failure, 2013. 19 (1): p. 16-24. Doerner, J., et al., Incremental value of cardiovascular magnetic resonance feature tracking derived atrial and ventricular strain parameters in a comprehensive approach for the diagnosis of acute myocarditis. European journal of radiology, 2018. 104 : p. 120-128. Gavara, J., et al., Prognostic value of strain by tissue tracking cardiac magnetic resonance after ST-segment elevation myocardial infarction. JACC: Cardiovascular Imaging, 2018. 11 (10): p. 1448-1457. Longobardo, L., et al., Role of two-dimensional speckle-tracking echocardiography strain in the assessment of right ventricular systolic function and comparison with conventional parameters. Journal of the American Society of Echocardiography, 2017. 30 (10): p. 937-946. e6. Carluccio, E., et al., Prognostic value of right ventricular dysfunction in heart failure with reduced ejection fraction: superiority of longitudinal strain over tricuspid annular plane systolic excursion. Circulation: Cardiovascular Imaging, 2018. 11 (1): p. e006894. Meris, A., et al., Timing and magnitude of regional right ventricular function: a speckle tracking-derived strain study of normal subjects and patients with right ventricular dysfunction. J Am Soc Echocardiogr, 2010. 23 (8): p. 823-31. Cameli, M., et al. Right ventricular longitudinal strain and right ventricular stroke work index in patients with severe heart failure: left ventricular assist device suitability for transplant candidates . in Transplantation proceedings . 2012. Elsevier. Carluccio, E., et al., Superior Prognostic Value of Right Ventricular Free Wall Compared to Global Longitudinal Strain in Patients With Heart Failure. J Am Soc Echocardiogr, 2019. 32 (7): p. 836-844.e1. Houard, L., et al., Additional Prognostic Value of 2D Right Ventricular Speckle-Tracking Strain for Prediction of Survival in Heart Failure and Reduced Ejection Fraction: A Comparative Study With Cardiac Magnetic Resonance. JACC: Cardiovascular Imaging, 2019. 12 (12): p. 2373-2385. Beck, D.R., et al., Right Ventricular Longitudinal Strain In Left Ventricular Assist Device Surgery-A Retrospective Cohort Study. J Cardiothorac Vasc Anesth, 2017. 31 (6): p. 2096-2102. Boegershausen, N., et al., Risk factors for the development of right ventricular failure after left ventricular assist device implantation—a single-centre retrospective with focus on deformation imaging†. European Journal of Cardio-Thoracic Surgery, 2017. 52 (6): p. 1069-1076. Bowen, D.J., et al., Right ventricular functional assessment by 2D multi-plane echocardiography prior to left ventricular assist device implantation. Echocardiography, 2022. 39 (1): p. 7-19. Cameli, M., et al., Speckle tracking echocardiography as a new technique to evaluate right ventricular function in patients with left ventricular assist device therapy. J Heart Lung Transplant, 2013. 32 (4): p. 424-30. Charisopoulou, D., et al., Right atrial and ventricular echocardiographic strain analysis predicts requirement for right ventricular support after left ventricular assist device implantation. Eur Heart J Cardiovasc Imaging, 2019. 20 (2): p. 199-208. Dufendach, K.A., et al., Pre-implant right ventricular free wall strain predicts post-LVAD right heart failure. J Card Surg, 2021. 36 (6): p. 1996-2003. Gumus, F., et al., Right ventricular free wall longitudinal strain and stroke work index for predicting right heart failure after left ventricular assist device therapy. Interact Cardiovasc Thorac Surg, 2019. 28 (5): p. 674-682. Isaza, N., et al., Incremental Value of Global Longitudinal Strain to Michigan Risk Score and Pulmonary Artery Pulsatility Index in Predicting Right Ventricular Failure Following Left Ventricular Assist Devices. Heart Lung Circ, 2022. 31 (8): p. 1110-1118. Kato, T.S., et al., Serial echocardiography using tissue Doppler and speckle tracking imaging to monitor right ventricular failure before and after left ventricular assist device surgery. JACC Heart Fail, 2013. 1 (3): p. 216-22. Magunia, H., et al., 3D echocardiography derived right ventricular function is associated with right ventricular failure and mid-term survival after left ventricular assist device implantation. Int J Cardiol, 2018. 272 : p. 348-355. Silverton, N.A., et al., Intraoperative Transesophageal Echocardiography and Right Ventricular Failure After Left Ventricular Assist Device Implantation. J Cardiothorac Vasc Anesth, 2018. 32 (5): p. 2096-2103. Stricagnoli, M., et al., Clinical, echocardiographic and hemodynamic predictors of right heart failure after LVAD placement. Int J Cardiovasc Imaging, 2022. 38 (3): p. 561-570. Tables Name Year Type RHF No RHF Strain Type Mean Age (years) Mean Follow Up (months) Gender (% male) Beck [22] 2017 Retro 21 36 FWS 53 6 81 Boegershausen [23] 2017 Retro 12 32 GLS 61 6 85 Bowen [24] 2022 Retro 7 18 FWS 59 1 76 Cameli [25] 2013 Pro 3 7 FWS, GLS 66 18 90 Charisopoulou [26] 2019 Retro 14 56 FWS, GLS, SLS 47 1 84 Dufendach [27] 2021 Retro 27 110 FWS, GLS 58 12 85 Gumus [28] 2019 Retro 20 37 FWS, GLS, SLS 40 25 81 Isaza [29] 2022 Retro 66 180 FWS, GLS 54 42 79 Kato [30] 2013 Pro 24 44 GLS 63 1 90 Liang [11] 2022 Retro 28 27 FWS, GLS, SLS 56 36 84 Magunia [31] 2018 Retro 5 21 FWS, SLS 62 12 92 Silverton [32] 2018 Retro 19 81 FWS, GLS 61 1 89 Stricagnoli [33] 2022 Pro 8 30 FWS 63 36 88 Table 1. Demographic data of the included studies. RHF: Right heart failure. FWS: Free wall strain. GLS: Global longitudinal strain. SLS: Septal longitudinal strain. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4046496","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":277712298,"identity":"387296d3-cc2f-4b6f-8774-39d1fd6a2c5c","order_by":0,"name":"Jesse Frye","email":"data:image/png;base64,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","orcid":"","institution":"Stony Brook University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Jesse","middleName":"","lastName":"Frye","suffix":""},{"id":277712299,"identity":"97071667-5b96-4772-a37a-07f1777dba75","order_by":1,"name":"Michael Tao","email":"","orcid":"","institution":"Stony Brook University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Tao","suffix":""},{"id":277712302,"identity":"2bf320a7-c6ed-4f44-be3e-f478e8efacb1","order_by":2,"name":"Simrat Dhaliwal","email":"","orcid":"","institution":"Stony Brook University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Simrat","middleName":"","lastName":"Dhaliwal","suffix":""},{"id":277712306,"identity":"54605195-b823-4a49-997e-1277a2549f18","order_by":3,"name":"Edlira Tam","email":"","orcid":"","institution":"Stony Brook University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Edlira","middleName":"","lastName":"Tam","suffix":""},{"id":277712307,"identity":"fec98850-08b8-4974-9891-b177581e57f4","order_by":4,"name":"Marc Goldschmidt","email":"","orcid":"","institution":"Stony Brook University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Marc","middleName":"","lastName":"Goldschmidt","suffix":""},{"id":277712308,"identity":"b5670e4d-4d88-4bda-b5d7-5ee3f3ccae63","order_by":5,"name":"Noelle Mann","email":"","orcid":"","institution":"Stony Brook University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Noelle","middleName":"","lastName":"Mann","suffix":""},{"id":277712309,"identity":"385823b0-ab8f-44d6-8ca4-6e4bc036d2eb","order_by":6,"name":"Smadar Kort","email":"","orcid":"","institution":"Stony Brook University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Smadar","middleName":"","lastName":"Kort","suffix":""}],"badges":[],"createdAt":"2024-03-08 15:48:01","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4046496/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4046496/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52542872,"identity":"6dbf9287-42b7-4f17-abd3-517e52c3a631","added_by":"auto","created_at":"2024-03-12 17:46:41","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":80187,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram depicting study selection for inclusion based on the PRISMA statement for reporting systematic reviews and meta-analyses.\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4046496/v1/954101bfde515f1ccb4e1c6d.jpg"},{"id":52542874,"identity":"a404e9d9-53b0-4c15-94ff-08fe5c4f7e8b","added_by":"auto","created_at":"2024-03-12 17:46:42","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":46748,"visible":true,"origin":"","legend":"\u003cp\u003eAssociation between RV FWS and postimplant RHF\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4046496/v1/addc079f56bd234b6d3dd43a.jpg"},{"id":52542875,"identity":"98072800-bc44-4990-9a1f-f53a2404f46d","added_by":"auto","created_at":"2024-03-12 17:46:42","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":42043,"visible":true,"origin":"","legend":"\u003cp\u003eAssociation between RV GLS and postimplant RHF.\u003c/p\u003e","description":"","filename":"Picture3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4046496/v1/8b008b24b8ddf17bc03cea29.jpg"},{"id":52542876,"identity":"088fb25b-18ad-4034-b589-e34b6b967b2a","added_by":"auto","created_at":"2024-03-12 17:46:43","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":26900,"visible":true,"origin":"","legend":"\u003cp\u003eAssociation between RV SLS and RHF.\u003c/p\u003e","description":"","filename":"Picture4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4046496/v1/3e9de01cb4501d60bef7349b.jpg"},{"id":52591704,"identity":"ffebf8b3-dd5e-48b2-a9fe-bd05e6949019","added_by":"auto","created_at":"2024-03-13 10:35:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":355744,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4046496/v1/d2e21b03-ba5c-4415-95fb-461298d276c4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Use of Speckle Tracking Echocardiography to Predict Right Heart Failure Following Left Ventricular Assist Device Implantation: A Systematic Review and Meta-Analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHeart Failure (HF) continues to pose a global health and financial challenge, affecting over 23 million individuals worldwide and is responsible for a large proportion of hospitalizations for individuals 65 and older\u0026nbsp;[1, 2]. The disease is progressive, incurable, and prognosis is poor, especially when someone\u0026rsquo;s clinical condition is refractory to pharmacologic therapy. \u0026nbsp;Since the 1990s, heart transplant (HT) gained popularity as a potential treatment in end-stage HF\u0026nbsp;[3]. Soon after, the advent of temporary MCS via LVAD followed to allow for bridge-to-transplant. However, HT has its limitations, especially when faced with limited organ availability\u0026nbsp;[4]. The REMATCH (Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure) trial in 2001 demonstrated groundbreaking potential for LVADs as destination therapy for end-stage HF patients[5]. Now nearly 50% of LVAD use constitutes destination therapy\u0026nbsp;[6].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe outcome of patients treated with LVADs is in part determined by post implantation RV function. RHF occurs in 20-40% of patients post-LVAD and is subsequently associated with worse outcomes, and greater morality rates\u0026nbsp;[7, 8]. The etiology of RHF is multifactorial, ranging from increased preload stress, to the unsupported right ventricle (RV), to worsening pre-existing tricuspid regurgitation\u0026nbsp;[9-11]. Worsening of pre-existing undiagnosed RV dysfunction is also a potential contributor that has not been well studied, and the incidence of it is unknown. Thus, pre-implant assessment of the RV is crucial and standard of care\u0026nbsp;[12].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTraditionally, transthoracic echocardiogram (TTE) has been used to assess RV function to prognosticate RHF in pre-LVAD implant patients. However traditional TTE parameters, such as tricuspid annular planar systolic excursion and fractional area change, poorly predict RHF\u0026nbsp;[13]. \u0026nbsp;Speckle-tracking echocardiography (STE) may provide a potential diagnostic tool by providing information on myocardial deformation via RV strain. Strain values can be derived in several parameters: global longitudinal strain (GLS), free wall strain (FWS), and septal longitudinal strain (SLS). STE has been utilized as a prognostic tool in other cardiac pathologies, however, data on the use of STE to predict RHF post-LVAD implant patients is limited\u0026nbsp;[14, 15]; thus \u0026nbsp;seeks to summarize the evidence regarding the prognostic role of RV strain imaging in patients pre-LVAD in predicting RV failure.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eStudy Selection and Data Collection\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA review of the literature was performed in the following databases: Pubmed, EMBASE, and Web of Science. The goal was to find studies analyzing the relationship between preoperative right heart strain parameters and RV failure following LVAD placement. The primary endpoint was postoperative RV failure. RV failure included the need for salvage RVAD, prolonged inotropic support, or prolonged pulmonary vasodilator therapy. The following keywords were used:\u0026nbsp;\u0026ldquo;LVAD,\u0026rdquo; \u0026ldquo;ventricular assist device,\u0026rdquo; \u0026ldquo;strain,\u0026rdquo; \u0026ldquo;right ventricular strain.\u0026rdquo; The full text of each study was manually reviewed to ensure its data was relevant to the study endpoint.\u003c/p\u003e\n\u003cp\u003eA study was selected if it included patients undergoing LVAD implantation, comparing RV strain parameters (free wall strain, global longitudinal strain, septal longitudinal strain) in those who had postoperative RHF versus those who did not have postoperative RHF.\u003c/p\u003e\n\u003cp\u003eData was separately collected by two reviewers (JF and MT). The following data was collected:\u0026nbsp;Lead author, year of publication, study design, follow up, age, gender, RHF, strain parameters, comorbidities, and INTERMACS class.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical Analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe program \u0026ldquo;Comprehensive Meta-Analysis software, version 3.6\u0026rdquo; was utilized for the statistical aspect of the meta-analysis. A random-effects model was used to analyze the association between RV strain and RV failure. Data was analyzed in the form of an Odds-Ratio. Heterogeneity was calculated with an I2, and the data was said to be statistically significant if the p-value was \u0026lt; 0.05 in a two-test.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eWe found 582 records through our initial screen. Of them, 13 studies met inclusion criteria for the meta-analysis (Figure 1). There was a total of 933 patients included, 254 with RV failure and 679 without RV failure. The average age was 55.9, the average follow-up was 15 months, and 85% were male. 821 patients had RV FWS imaging, 787 patients had RV GLS imaging, and 208 patients had RV SLS imaging.\u003c/p\u003e\n\u003cp\u003eBaseline RVFWS, RVGLS, and RVSLS were all significantly reduced in patients who had postoperative RV failure when compared to patients who did not have postoperative RV failure. (MD 3.77, 95% CI 2.39, 5.15; p\u0026lt;0.01; MD 2.67, 95% CI 1.16, 4.17; p\u0026lt;0.01; MD 3.59, 95% CI 0.83, 6.35; p=0.01) (Figure 2, Figure 3, Figure 4). The effect size was largest for RVFWS compared to RVGLS and RVSLS (Z=5.35, Z=3.47, Z=2.55 respectively). All three analyses had significant heterogeneity (RVFWS I2=88%, RVGLS I2=92%, RVSLS I2=83%), likely due to vendor-specific differences in strain measurements and echo lab protocols. We used a random-effects model to address this.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis meta-analysis evaluated the role of strain imaging performed before LVAD implant to risk stratify patients for the development of postoperative RV failure. The main findings were as follows: (a) baseline RVFWS, RVGLS, and RVSLS were all significantly reduced in patients who subsequently developed post-implantation RHF compared to patients who did not develop this outcome; (b) the effect size was largest for RVFWS compared to RVGLS and RVSLS.\u003c/p\u003e\n\u003cp\u003eRHF is the leading cause of mortality post-implantation of an LVAD. Although various mechanisms proposed for development of RV dysfunction post implant, it is possible that in some patients, subclinical RV dysfunction was present before LVAD implantation, and due to increased preload, deteriorated to a point that overt dysfunction developed. \u0026nbsp;Traditionally, TTE has been extensively used pre-LVAD implantation for risk assessment of developing post-implantation RHF. However, TTE parameters exhibit limited sensitivity in predicting adverse cardiovascular outcomes, primarily due to their reliance on geometric assumptions [13]. While cardiac magnetic resonance imaging, along with various risk scores, could offer more sensitive assessment, the higher cost associated with it, making this approach less desirable as a routine screening approach, TTE with the addition of Speckle-Tracking Echocardiography (STE) offer more cost-effective and automated user-independent alternatives. Notably, STE generated RVGLS and RVFWS have shown superior accuracy in assessing RV function compared to other measures, such as FAC and TAPSE[16, 17]. The RV is mainly composed of longitudinal fibers, and these fibers, located within the subendocardial layer, allow for systolic shortening [18]. STE strain assesses the degree of ventricular contraction in this longitudinal direction via GLS, SLS and FWS. A decrease in baseline longitudinal strain may indicate underlying subclinical inflammation and fibrosis affecting the subendocardial layer, leading to ventricular remodeling and eventual post-implantation RHF. Consequently, the association between reduced RVGLS, RVSLS, and RVFWS and an elevated risk for post-implantation RHF is not surprising.\u003c/p\u003e\n\u003cp\u003eWhen comparing the various strain parameters, our results reveal that RVFWS is associated with the greatest effect size. Two prior studies, Cameli et al. and Carluccio et al., demonstrated that RVFWS appears to hold the greatest accuracy for predicting RV dysfunction, mainly because it is less influenced by LV dysfunction [19, 20]. RVGLS, although more reproducible when assessing RV dysfunction than RVFWS [21], \u0026nbsp;assess also the interventricular septum in its analysis, therefore less specific for RV dysfunction. \u0026nbsp;In summary, STE offers a distinct advantage over conventional TTE in evaluation RV function. \u0026nbsp;The incorporation of multiple RV strain parameters enhances the potential for precise and replicable prognostication of post-implantation RHF.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study suggests that STE with strain analysis could help risk stratify pre-LVAD patients for the development of post-implantation RHF. As this tool is now readily available on clinically used echo machines, and artificial intelligent as well as deep machine learning allow for automated acquisition and interpretation of the data, incorporating STE into pre LVAD assessment may become the routine practice.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study has several limitations. Firstly, the exclusion of subjects with specific comorbidities in the studies cited may reduce the general applicability of our findings to the broader population. Furthermore, there was notable heterogeneity, likely stemming from vendor-specific variations in strain measurements and STE lab protocols. To address this issue, a random-effects model may be beneficial. While our study focuses on RHF, further high-quality research is essential to clarify the association of reduced strain measurements with other cardiovascular outcomes in LVAD patients. Lastly, it is unknown whether identifying patients at risk for developing RHF could improve their outcome, and research to assess it is essential.\u0026nbsp;\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eFAC: fractional area change\u003c/p\u003e\n\u003cp\u003eFWS: free wall strain\u003c/p\u003e\n\u003cp\u003eGLS: global longitudinal strain\u003c/p\u003e\n\u003cp\u003eHF: heart failure\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHT: heart transplant\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLVADs: left ventricular assist devices\u003c/p\u003e\n\u003cp\u003eLVEF: left ventricular ejection fraction\u003c/p\u003e\n\u003cp\u003eMCS: mechanical circulatory support\u003c/p\u003e\n\u003cp\u003eRHF: right heart failure\u003c/p\u003e\n\u003cp\u003eRV: right ventricle\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSLS: strain of a line segment\u003c/p\u003e\n\u003cp\u003eSTE: speckle-tracking echocardiography\u003c/p\u003e\n\u003cp\u003eTAPSE: tricuspid annular plane systolic excursion\u003c/p\u003e\n\u003cp\u003eTTE: transthoracic echocardiogram\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eData Availability Statement: The data underlying this article will be shared on reasonable request to the corresponding author.\u003c/p\u003e\n\u003cp\u003eFinancial Disclosures: None\u003c/p\u003e\n\u003cp\u003eConflicts of Interest: None\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBui, A.L., T.B. Horwich, and G.C. Fonarow, \u003cem\u003eEpidemiology and risk profile of heart failure.\u003c/em\u003e Nature Reviews Cardiology, 2011. \u003cstrong\u003e8\u003c/strong\u003e(1): p. 30-41.\u003c/li\u003e\n\u003cli\u003eRoger, V.L., et al., \u003cem\u003eTrends in heart failure incidence and survival in a community-based population.\u003c/em\u003e Jama, 2004. \u003cstrong\u003e292\u003c/strong\u003e(3): p. 344-350.\u003c/li\u003e\n\u003cli\u003eAhmed, T. and A. Jain, \u003cem\u003eHeart Transplantation\u003c/em\u003e, in \u003cem\u003eStatPearls\u003c/em\u003e. 2023, StatPearls Publishing Copyright \u0026copy; 2023, StatPearls Publishing LLC.: Treasure Island (FL) ineligible companies. Disclosure: Ankit Jain declares no relevant financial relationships with ineligible companies.\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"4\"\u003e\n\u003cli\u003eSchwarz, E.R., et al., \u003cem\u003eMaximal care considerations when treating patients with end-stage heart failure: ethical and procedural quandaries in management of the very sick.\u003c/em\u003e Journal of religion and health, 2011. \u003cstrong\u003e50\u003c/strong\u003e: p. 872-879.\u003c/li\u003e\n\u003cli\u003eRose, E.A., et al., \u003cem\u003eLong-term use of a left ventricular assist device for end-stage heart failure.\u003c/em\u003e New England Journal of Medicine, 2001. \u003cstrong\u003e345\u003c/strong\u003e(20): p. 1435-1443.\u003c/li\u003e\n\u003cli\u003eKirklin, J.K., et al., \u003cem\u003eEighth annual INTERMACS report: special focus on framing the impact of adverse events.\u003c/em\u003e The Journal of Heart and Lung Transplantation, 2017. \u003cstrong\u003e36\u003c/strong\u003e(10): p. 1080-1086.\u003c/li\u003e\n\u003cli\u003eDang, N.C., et al., \u003cem\u003eRight heart failure after left ventricular assist device implantation in patients with chronic congestive heart failure.\u003c/em\u003e The Journal of heart and lung transplantation, 2006. \u003cstrong\u003e25\u003c/strong\u003e(1): p. 1-6.\u003c/li\u003e\n\u003cli\u003eKormos, R.L., et al., \u003cem\u003eRight ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: incidence, risk factors, and effect on outcomes.\u003c/em\u003e The Journal of thoracic and cardiovascular surgery, 2010. \u003cstrong\u003e139\u003c/strong\u003e(5): p. 1316-1324.\u003c/li\u003e\n\u003cli\u003eFarrar, D.J., et al., \u003cem\u003eRight heart interaction with the mechanically assisted left heart.\u003c/em\u003e World journal of surgery, 1985. \u003cstrong\u003e9\u003c/strong\u003e: p. 89-102.\u003c/li\u003e\n\u003cli\u003eMorgan, J.A., et al., \u003cem\u003eImpact of continuous-flow left ventricular assist device support on right ventricular function.\u003c/em\u003e The Journal of Heart and Lung Transplantation, 2013. \u003cstrong\u003e32\u003c/strong\u003e(4): p. 398-403.\u003c/li\u003e\n\u003cli\u003eLiang, L.W., et al., \u003cem\u003eRight Ventricular Global Longitudinal Strain as a Predictor of Acute and Early Right Heart Failure Post Left Ventricular Assist Device Implantation.\u003c/em\u003e Asaio j, 2022. \u003cstrong\u003e68\u003c/strong\u003e(3): p. 333-339.\u003c/li\u003e\n\u003cli\u003ePeura, J.L., et al., \u003cem\u003eRecommendations for the use of mechanical circulatory support: device strategies and patient selection: a scientific statement from the American Heart Association.\u003c/em\u003e Circulation, 2012. \u003cstrong\u003e126\u003c/strong\u003e(22): p. 2648-2667.\u003c/li\u003e\n\u003cli\u003eRaina, A., et al., \u003cem\u003ePostoperative right ventricular failure after left ventricular assist device placement is predicted by preoperative echocardiographic structural, hemodynamic, and functional parameters.\u003c/em\u003e Journal of cardiac failure, 2013. \u003cstrong\u003e19\u003c/strong\u003e(1): p. 16-24.\u003c/li\u003e\n\u003cli\u003eDoerner, J., et al., \u003cem\u003eIncremental value of cardiovascular magnetic resonance feature tracking derived atrial and ventricular strain parameters in a comprehensive approach for the diagnosis of acute myocarditis.\u003c/em\u003e European journal of radiology, 2018. \u003cstrong\u003e104\u003c/strong\u003e: p. 120-128.\u003c/li\u003e\n\u003cli\u003eGavara, J., et al., \u003cem\u003ePrognostic value of strain by tissue tracking cardiac magnetic resonance after ST-segment elevation myocardial infarction.\u003c/em\u003e JACC: Cardiovascular Imaging, 2018. \u003cstrong\u003e11\u003c/strong\u003e(10): p. 1448-1457.\u003c/li\u003e\n\u003cli\u003eLongobardo, L., et al., \u003cem\u003eRole of two-dimensional speckle-tracking echocardiography strain in the assessment of right ventricular systolic function and comparison with conventional parameters.\u003c/em\u003e Journal of the American Society of Echocardiography, 2017. \u003cstrong\u003e30\u003c/strong\u003e(10): p. 937-946. e6.\u003c/li\u003e\n\u003cli\u003eCarluccio, E., et al., \u003cem\u003ePrognostic value of right ventricular dysfunction in heart failure with reduced ejection fraction: superiority of longitudinal strain over tricuspid annular plane systolic excursion.\u003c/em\u003e Circulation: Cardiovascular Imaging, 2018. \u003cstrong\u003e11\u003c/strong\u003e(1): p. e006894.\u003c/li\u003e\n\u003cli\u003eMeris, A., et al., \u003cem\u003eTiming and magnitude of regional right ventricular function: a speckle tracking-derived strain study of normal subjects and patients with right ventricular dysfunction.\u003c/em\u003e J Am Soc Echocardiogr, 2010. \u003cstrong\u003e23\u003c/strong\u003e(8): p. 823-31.\u003c/li\u003e\n\u003cli\u003eCameli, M., et al. \u003cem\u003eRight ventricular longitudinal strain and right ventricular stroke work index in patients with severe heart failure: left ventricular assist device suitability for transplant candidates\u003c/em\u003e. in \u003cem\u003eTransplantation proceedings\u003c/em\u003e. 2012. Elsevier.\u003c/li\u003e\n\u003cli\u003eCarluccio, E., et al., \u003cem\u003eSuperior Prognostic Value of Right Ventricular Free Wall Compared to Global Longitudinal Strain in Patients With Heart Failure.\u003c/em\u003e J Am Soc Echocardiogr, 2019. \u003cstrong\u003e32\u003c/strong\u003e(7): p. 836-844.e1.\u003c/li\u003e\n\u003cli\u003eHouard, L., et al., \u003cem\u003eAdditional Prognostic Value of 2D Right Ventricular Speckle-Tracking Strain for Prediction of Survival in Heart Failure and Reduced Ejection Fraction: A Comparative Study With Cardiac Magnetic Resonance.\u003c/em\u003e JACC: Cardiovascular Imaging, 2019. \u003cstrong\u003e12\u003c/strong\u003e(12): p. 2373-2385.\u003c/li\u003e\n\u003cli\u003eBeck, D.R., et al., \u003cem\u003eRight Ventricular Longitudinal Strain In Left Ventricular Assist Device Surgery-A Retrospective Cohort Study.\u003c/em\u003e J Cardiothorac Vasc Anesth, 2017. \u003cstrong\u003e31\u003c/strong\u003e(6): p. 2096-2102.\u003c/li\u003e\n\u003cli\u003eBoegershausen, N., et al., \u003cem\u003eRisk factors for the development of right ventricular failure after left ventricular assist device implantation\u0026mdash;a single-centre retrospective with focus on deformation imaging\u0026dagger;.\u003c/em\u003e European Journal of Cardio-Thoracic Surgery, 2017. \u003cstrong\u003e52\u003c/strong\u003e(6): p. 1069-1076.\u003c/li\u003e\n\u003cli\u003eBowen, D.J., et al., \u003cem\u003eRight ventricular functional assessment by 2D multi-plane echocardiography prior to left ventricular assist device implantation.\u003c/em\u003e Echocardiography, 2022. \u003cstrong\u003e39\u003c/strong\u003e(1): p. 7-19.\u003c/li\u003e\n\u003cli\u003eCameli, M., et al., \u003cem\u003eSpeckle tracking echocardiography as a new technique to evaluate right ventricular function in patients with left ventricular assist device therapy.\u003c/em\u003e J Heart Lung Transplant, 2013. \u003cstrong\u003e32\u003c/strong\u003e(4): p. 424-30.\u003c/li\u003e\n\u003cli\u003eCharisopoulou, D., et al., \u003cem\u003eRight atrial and ventricular echocardiographic strain analysis predicts requirement for right ventricular support after left ventricular assist device implantation.\u003c/em\u003e Eur Heart J Cardiovasc Imaging, 2019. \u003cstrong\u003e20\u003c/strong\u003e(2): p. 199-208.\u003c/li\u003e\n\u003cli\u003eDufendach, K.A., et al., \u003cem\u003ePre-implant right ventricular free wall strain predicts post-LVAD right heart failure.\u003c/em\u003e J Card Surg, 2021. \u003cstrong\u003e36\u003c/strong\u003e(6): p. 1996-2003.\u003c/li\u003e\n\u003cli\u003eGumus, F., et al., \u003cem\u003eRight ventricular free wall longitudinal strain and stroke work index for predicting right heart failure after left ventricular assist device therapy.\u003c/em\u003e Interact Cardiovasc Thorac Surg, 2019. \u003cstrong\u003e28\u003c/strong\u003e(5): p. 674-682.\u003c/li\u003e\n\u003cli\u003eIsaza, N., et al., \u003cem\u003eIncremental Value of Global Longitudinal Strain to Michigan Risk Score and Pulmonary Artery Pulsatility Index in Predicting Right Ventricular Failure Following Left Ventricular Assist Devices.\u003c/em\u003e Heart Lung Circ, 2022. \u003cstrong\u003e31\u003c/strong\u003e(8): p. 1110-1118.\u003c/li\u003e\n\u003cli\u003eKato, T.S., et al., \u003cem\u003eSerial echocardiography using tissue Doppler and speckle tracking imaging to monitor right ventricular failure before and after left ventricular assist device surgery.\u003c/em\u003e JACC Heart Fail, 2013. \u003cstrong\u003e1\u003c/strong\u003e(3): p. 216-22.\u003c/li\u003e\n\u003cli\u003eMagunia, H., et al., \u003cem\u003e3D echocardiography derived right ventricular function is associated with right ventricular failure and mid-term survival after left ventricular assist device implantation.\u003c/em\u003e Int J Cardiol, 2018. \u003cstrong\u003e272\u003c/strong\u003e: p. 348-355.\u003c/li\u003e\n\u003cli\u003eSilverton, N.A., et al., \u003cem\u003eIntraoperative Transesophageal Echocardiography and Right Ventricular Failure After Left Ventricular Assist Device Implantation.\u003c/em\u003e J Cardiothorac Vasc Anesth, 2018. \u003cstrong\u003e32\u003c/strong\u003e(5): p. 2096-2103.\u003c/li\u003e\n\u003cli\u003eStricagnoli, M., et al., \u003cem\u003eClinical, echocardiographic and hemodynamic predictors of right heart failure after LVAD placement.\u003c/em\u003e Int J Cardiovasc Imaging, 2022. \u003cstrong\u003e38\u003c/strong\u003e(3): p. 561-570.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"561\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.821428571428571%\"\u003e\n \u003cp\u003eName\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.607142857142858%\"\u003e\n \u003cp\u003eYear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\"\u003e\n \u003cp\u003eType\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.428571428571429%\"\u003e\n \u003cp\u003eRHF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.785714285714286%\"\u003e\n \u003cp\u003eNo RHF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.107142857142858%\"\u003e\n \u003cp\u003eStrain Type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003eMean Age (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.75%\"\u003e\n \u003cp\u003eMean Follow Up (months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.357142857142858%\"\u003e\n \u003cp\u003eGender (% male)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.821428571428571%\" valign=\"bottom\"\u003e\n \u003cp\u003eBeck\u003csup\u003e[22]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.607142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"bottom\"\u003e\n \u003cp\u003eRetro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.428571428571429%\" valign=\"bottom\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.785714285714286%\" valign=\"bottom\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.107142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003eFWS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" valign=\"bottom\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.75%\" valign=\"bottom\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.357142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.821428571428571%\" valign=\"bottom\"\u003e\n \u003cp\u003eBoegershausen\u003csup\u003e[23]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.607142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"bottom\"\u003e\n \u003cp\u003eRetro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.428571428571429%\" valign=\"bottom\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.785714285714286%\" valign=\"bottom\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.107142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003eGLS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" valign=\"bottom\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.75%\" valign=\"bottom\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.357142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.821428571428571%\" valign=\"bottom\"\u003e\n \u003cp\u003eBowen\u003csup\u003e[24]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.607142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"bottom\"\u003e\n \u003cp\u003eRetro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.428571428571429%\" valign=\"bottom\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.785714285714286%\" valign=\"bottom\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.107142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003eFWS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" valign=\"bottom\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.75%\" valign=\"bottom\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.357142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.821428571428571%\" valign=\"bottom\"\u003e\n \u003cp\u003eCameli\u003csup\u003e[25]\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.607142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e2013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"bottom\"\u003e\n \u003cp\u003ePro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.428571428571429%\" valign=\"bottom\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.785714285714286%\" valign=\"bottom\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.107142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003eFWS, GLS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" valign=\"bottom\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.75%\" valign=\"bottom\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.357142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.821428571428571%\" valign=\"bottom\"\u003e\n \u003cp\u003eCharisopoulou\u003csup\u003e[26]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.607142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"bottom\"\u003e\n \u003cp\u003eRetro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.428571428571429%\" valign=\"bottom\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.785714285714286%\" valign=\"bottom\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.107142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003eFWS, GLS, SLS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" valign=\"bottom\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.75%\" valign=\"bottom\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.357142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.821428571428571%\" valign=\"bottom\"\u003e\n \u003cp\u003eDufendach\u003csup\u003e[27]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.607142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"bottom\"\u003e\n \u003cp\u003eRetro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.428571428571429%\" valign=\"bottom\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.785714285714286%\" valign=\"bottom\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.107142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003eFWS, GLS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" valign=\"bottom\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.75%\" valign=\"bottom\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.357142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.821428571428571%\" valign=\"bottom\"\u003e\n \u003cp\u003eGumus\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e[28]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.607142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"bottom\"\u003e\n \u003cp\u003eRetro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.428571428571429%\" valign=\"bottom\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.785714285714286%\" valign=\"bottom\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.107142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003eFWS, GLS, SLS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" valign=\"bottom\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.75%\" valign=\"bottom\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.357142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.821428571428571%\" valign=\"bottom\"\u003e\n \u003cp\u003eIsaza\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e[29]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.607142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"bottom\"\u003e\n \u003cp\u003eRetro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.428571428571429%\" valign=\"bottom\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.785714285714286%\" valign=\"bottom\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.107142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003eFWS, GLS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" valign=\"bottom\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.75%\" valign=\"bottom\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.357142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.821428571428571%\" valign=\"bottom\"\u003e\n \u003cp\u003eKato\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e[30]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.607142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e2013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"bottom\"\u003e\n \u003cp\u003ePro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.428571428571429%\" valign=\"bottom\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.785714285714286%\" valign=\"bottom\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.107142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003eGLS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" valign=\"bottom\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.75%\" valign=\"bottom\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.357142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.821428571428571%\" valign=\"bottom\"\u003e\n \u003cp\u003eLiang\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e[11]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.607142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"bottom\"\u003e\n \u003cp\u003eRetro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.428571428571429%\" valign=\"bottom\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.785714285714286%\" valign=\"bottom\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.107142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003eFWS, GLS, SLS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" valign=\"bottom\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.75%\" valign=\"bottom\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.357142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.821428571428571%\" valign=\"bottom\"\u003e\n \u003cp\u003eMagunia\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e[31]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.607142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"bottom\"\u003e\n \u003cp\u003eRetro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.428571428571429%\" valign=\"bottom\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.785714285714286%\" valign=\"bottom\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.107142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003eFWS, SLS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" valign=\"bottom\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.75%\" valign=\"bottom\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.357142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.821428571428571%\" valign=\"bottom\"\u003e\n \u003cp\u003eSilverton\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e[32]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.607142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"bottom\"\u003e\n \u003cp\u003eRetro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.428571428571429%\" valign=\"bottom\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.785714285714286%\" valign=\"bottom\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.107142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003eFWS, GLS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" valign=\"bottom\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.75%\" valign=\"bottom\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.357142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.821428571428571%\" valign=\"bottom\"\u003e\n \u003cp\u003eStricagnoli\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e[33]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.607142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"bottom\"\u003e\n \u003cp\u003ePro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.428571428571429%\" valign=\"bottom\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.785714285714286%\" valign=\"bottom\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.107142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003eFWS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\" valign=\"bottom\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.75%\" valign=\"bottom\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.357142857142858%\" valign=\"bottom\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 1. Demographic data of the included studies. RHF: Right heart failure. FWS: Free wall strain. GLS: Global longitudinal strain. SLS: Septal longitudinal strain.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Speckle tracking echocardiography, LVAD, right heart failure","lastPublishedDoi":"10.21203/rs.3.rs-4046496/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4046496/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction\u003c/p\u003e\n\u003cp\u003eRight Heart Failure (RHF) is an important consequence of implant of left ventricular assist devices (LVAD). Right ventricular (RV) analysis with speckle tracking echo (STE) can assist in the assessment of the RV. This meta-analysis examines preoperative RV strain on STE as a predictor of postoperative RHF.\u003c/p\u003e\n\u003cp\u003eMethods\u003c/p\u003e\n\u003cp\u003eLiterature was reviewed in Pubmed, EMBASE, and Web of Science for studies reporting on the association of preoperative RV free wall (FWS), global longitudinal (GLS), and septal longitudinal (SLS) strain with postoperative RV failure following LVAD placement. Strain parameters were compared between the two groups.\u003c/p\u003e\n\u003cp\u003eResults\u003c/p\u003e\n\u003cp\u003eA total of 13 studies with 933 patients undergoing LVAD implantation met inclusion criteria. 254 patients subsequently developed RHF and 679 did not develop RHF. Mean follow up was 15 months. The mean age of participants was 55.9 years and 85% were male. Baseline RVFWS, RVGLS, and RVSLS were significantly reduced in patients who developed post-implantation RHF compared to patients who did not develop post-implantation RHF (MD 3.77, 95% CI 2.39, 5.15; p\u0026lt;0.01; MD 2.67, 95% CI 1.16, 4.17; p\u0026lt;0.01; MD 3.59, 95% CI 0.83, 6.35; p=0.01). The heterogeneity was considerable for all three analyses (RVFWS I2=88%, RVGLS I2=92%, RVSLS I2=83%), likely due to vendor-specific differences in strain measurements and differences in echocardiography lab protocols. To address this, a random-effects model was used.\u003c/p\u003e\n\u003cp\u003eConclusions\u003c/p\u003e\n\u003cp\u003ePreoperative RV FWS, GLS, and SLS were all associated with postoperative RHF. STE may be helpful in risk stratification of RHF following LVAD implant.\u003c/p\u003e","manuscriptTitle":"Use of Speckle Tracking Echocardiography to Predict Right Heart Failure Following Left Ventricular Assist Device Implantation: A Systematic Review and Meta-Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-12 17:46:35","doi":"10.21203/rs.3.rs-4046496/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ba51d211-6184-4105-bbe0-b58c0fd592ec","owner":[],"postedDate":"March 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-13T10:34:39+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-12 17:46:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4046496","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4046496","identity":"rs-4046496","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}