right ventricular free-wall longitudinal strain (rvfwls) as a prognostic factor in patients with pulmonary arterial hypertension (pah): a systematic review and meta-analysis

Pulmonary arterial hypertension (pah) is characterized by progressive right ventricular (rv) dysfunction, the primary determinant of mortality. measured via speckle-tracking echocardiography, right ventricular free-wall longitudinal strain (rvfwls) has gained recognition as a promising prognostic marker. this meta-analysis evaluates the prognostic value of rvfwls in predicting all-cause mortality and composite outcomes in patients with pah. a systematic review and meta-analysis were performed according to prisma guidelines. studies reporting hazard ratios (hrs) for rvfwls in association with all-cause mortality or composite clinical outcomes in pah (who group 1) were identified through searches of scopus, pubmed, web of science, proquest, and science direct. both continuous and dichotomous rvfwls data were pooled using the random-effects model. the robustness of the findings was tested through sensitivity analyses, and heterogeneity was analyzed using the i² statistic. six studies involving 693 patients were included. the pooled analysis demonstrated that worse rvfwls values were significantly connected to all-cause mortality (hr: 1.59; 95% ci: 1.35-1.87; p < 0.0001). for composite outcomes, the pooled hr was 2.01 (95% ci: 0.78–5.19; p = 0.15), with high heterogeneity (i² = 81%). sensitivity analyses confirmed the robustness of mortality findings and identified variability in composite outcome definitions as a source of heterogeneity. these results demonstrate the consistent prognostic value of rvfwls across diverse clinical scenarios and study designs. rvfwls is a reliable prognostic marker for mortality in patients with pah. standardizing measurement techniques and outcome definitions will enhance the clinical utility and applicability of rvfwls.