RVEF had better prognostic value than LVEF in pulmonary hypertension (ratio 1.21, BF 20.1) and HFpEF (ratio 1.30, BF 3.6), while both were equal in DCM, CA, and HFrEF.
Does CMR-derived RVEF provide better prognostic value than LVEF for adverse outcomes in specific types of cardiovascular disease?
CMR-derived RVEF is a stronger prognosticator than LVEF in HFpEF and pulmonary hypertension, while both have equal prognostic value in HFrEF, dilated cardiomyopathy, and cardiac amyloidosis.
Absolute Event Rate: 0% vs 0%
Abstract Background Little is known about whether right ventricular ejection fraction (RVEF) is a more robust prognosticator than left ventricular ejection fraction (LVEF) of specific types of cardiovascular disease (CVD). Purpose The aim of this study was to compare cardiac magnetic resonance (CMR)-derived RVEF with LVEF in specific types of CVD for their association with outcomes in a systematic review with a Bayesian model-averaged meta-analysis. Methods Three databases were searched for CMR articles reporting hazard ratios (HRs) of LVEF and RVEF in relation to specific types of CVD. HRs were rescaled by within-study standard deviations (SD) and HRs for a 1-SD reduction in LVEF and RVEF were calculated. The ratio of HRs was calculated for a direct comparison between RVEF and LVEF. A Bayesian model-averaged meta-analysis was performed to assess the strength of evidence according to the Bayes factor (BF). Results In 87 articles (19,331 patients) analyzing 10 types of CVD, the pooled HR for a 1-SD reduction in LVEF provided strong evidence (BF≥10) of an association with outcomes in repaired Tetralogy of Fallot (rTOF), dilated cardiomyopathy (DCM), myocardial infarction/ischemic cardiomyopathy (MI.ICM), and cardiac amyloidosis (CA). Corresponding values of RVEF provided strong evidence (BF≥10) for rTOF, DCM, MI.ICM, pulmonary hypertension (PH), heart failure with preserved EF (HFpEF), and cardiac sarcoidosis. Moderate to strong evidence (BF ≥ 3) that the ratio of HR between RVEF and LVEF was greater than 1 was observed in HFpEF ratio: 1.30, 95% credible interval (CrI): 1.09-1.58, BF: 3.6 and PH (ratio: 1.21, 95% Crl: 1.09-1.35, BF: 20.1). This means that with moderate to strong evidence, RVEF was shown to have a better prognostic value than LVEF in these diseases. On the other hand, strong evidence for a ratio of HR between RVEF and LVEF of 1 was observed in DCM, cardiac amyloidosis and HF with reduced EF (HFrEF). This means that there is strong evidence that RVEF and LVEF have equal prognostic value in these diseases. Conclusions Both LVEF and RVEF were independently associated with adverse outcomes in relation to specific types of CVD. There was moderate evidence that RVEF is more strongly associated with prognosis than LVEF in PH and HFpEF, whereas there was strong evidence that LVEF and RVEF have equal prognostic power in HFrEF, dilated cardiomyopathy, and CA.Central illustration Figure
Kitano et al. (Sat,) reported a other. RVEF had better prognostic value than LVEF in pulmonary hypertension (ratio 1.21, BF 20.1) and HFpEF (ratio 1.30, BF 3.6), while both were equal in DCM, CA, and HFrEF.