Insights from 3D echocardiography: unveiling the prognostic value of RV function in pulmonary hypertension: a systematic review and meta-analysis

The role of right ventricular (RV) dysfunction in pulmonary hypertension (PH) has garnered increasing interest in terms of outcomes. This systematic review and meta-analysis evaluated the prognostic utility of three-dimensional echocardiography (3DE) derived right ventricular ejection fraction (RVEF) in PH. A systematic review and meta-analysis were performed using MEDLINE, Embase, and Scopus databases for publications reporting the hazard ratio (HR) of 3DE-derived RVEF in PH patients for the clinical end-points of composite outcome or all-cause mortality. Nine articles totaling 885 subjects were included, among which 67.23% had pulmonary arterial hypertension (PAH), with the remainder having a range of PH etiologies. The mean value of 3DE-derived RVEF was 35.5 ± 9.07% reflecting impaired RV function. The primary endpoint was all-cause mortality in three studies, while the rest of the studies reported composite outcomes. Follow-up duration ranges from 6 to 44 months. From seven publications, the pooled HR by 3DE-derived RVEF was 0.91 (95% CI: 0.85 to 0.97, p = 0.001; heterogeneity: I² = 62%, p = 0.004). In subgroup analysis, 3DE-derived RVEF was a significant prognostic factor for group 1 PH (HR: 0.90, CI: 0.86–0.94; heterogeneity I² = 43%, p < 0.0001). From meta-regression analysis, only follow-up duration was found statistically significant with the HR of RVEF in the population (estimate: 0.028, p = 0.026). 3DE-derived RVEF provides important prognostic value in a large population of PH patients, especially for group 1 PH. Further accumulation of evidence is needed to perform a detailed subgroup analysis in each type of PH.