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Assessment of Right Ventricular Function Following Left Ventricular Assist Device Implantation – The Role of Speckle-Tracking Echocardiography: A Meta-Analysis.
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  • Kirolos Barssoum,
  • Ahmed Altibi,
  • Devesh Rai,
  • Adnan Kharsa,
  • Medhat ChowdhuryOrcid,
  • Ahmed Elkaryoni,
  • Ahmed Abuzaid,
  • Bipul Baibhav,
  • Vishal Parikh,
  • Mallory Balmer-Swain,
  • Ahmad Masri,
  • Myriam Amsallem,
  • Navin C. Nanda
Kirolos Barssoum
Rochester General Hospital
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Ahmed Altibi
Henry Ford Allegiance Health
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Devesh Rai
Rochester General Hospital
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Adnan Kharsa
Rochester General Hospital
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Medhat Chowdhury
Orcid
Rochester General Hospital
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Ahmed Elkaryoni
Loyola University Medical Center
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Ahmed Abuzaid
Alaska Heart and Vascular Institute LLC
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Bipul Baibhav
Rochester Regional Health
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Vishal Parikh
Rochester General Hospital
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Mallory Balmer-Swain
Rochester General Hospital
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Ahmad Masri
Oregon Health & Science University
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Myriam Amsallem
Stanford University School of Medicine
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Navin C. Nanda
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Peer review status:UNDER REVIEW

17 Jun 2020Submitted to Echocardiography
17 Jun 2020Submission Checks Completed
17 Jun 2020Assigned to Editor
23 Jun 2020Reviewer(s) Assigned
15 Jul 2020Review(s) Completed, Editorial Evaluation Pending
17 Jul 2020Editorial Decision: Revise Major
24 Jul 20201st Revision Received
26 Jul 2020Submission Checks Completed
26 Jul 2020Assigned to Editor
26 Jul 2020Reviewer(s) Assigned

Abstract

Background: Right ventricular failure (RVF) following Left Ventricular Assist Device (LVAD) implantation is associated with worse outcomes. Prediction and early identification of RVF with speckle-tracking echocardiography (STE) has been proposed. Methods: We queried multiple databases for articles reporting on pre-operative/intraoperative global longitudinal strain (GLS) and free-wall strain (FWS) in LVAD recipients. We performed a systematic review and meta-analysis of published literature. The standard mean difference (SMD) in GLS and FWS in patients with and without RVF postoperatively was pooled using random effects model. Results: Fifteen studies, with a total of 967 LVAD recipients were included. There was statistically significant difference in GLS among patients who did and did not develop RVF; SMD= -3.09 (95% CI: -4.62 to -1.57; p-value <0.0001). There was significant difference in FWS between two groups; SMD: -2.75 (95% CI: -3.72 to -1.79; p-value <0.0001). Upon subgroup analysis of imaging modality, transthoracic echocardiography (TTE)-derived GLS and FWS remained predictive for RVF with SMD of -3.97 (95% CI: -5.40 to -2.54; p-value <0.001) and -3.05 (95% CI: -4.11 to -1.99; p-value <0.001), respectively. However, there was no significant difference between RVF and non-RVF groups upon using transesophageal echocardiography (TEE) to assess GLS and FWS. Conclusion: GLS and FWS assessment of the RV by STE is a useful tool to predict postoperative RVF in LVAD recipients. While the predictive role of TTE was robust, the TEE-derived measures seemed to be less predictive. Future studies need to specify the strain cut-off value that can predict the adverse outcome of RVF