Abstract
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Background
- We investigated differences in right-ventricular cardiac strain between survivor and non-survivor acute respiratory distress syndrome (ARDS) patients as measured by speckle tracking echocardiography.
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Methods
- We conducted a systematic search of PubMed and Scopus for relevant articles reporting data on all-cause mortality and right cardiac speckle tracking echocardiography in ARDS patients. We considered studies published up to May 4, 2025. The primary objectives of the meta-analysis were right-ventricular global and free-wall strain. A random effects model was used.
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Results
- We included 6 studies with a total population of 359 individuals. While right ventricular global longitudinal strain of intubated ARDS patients (mean difference [95% CI], –2.30 [–4.13 to –0.47], P=0.01) was greater among non-survivors, free wall strain [mean difference [95% CI], –2.78 [–6.83 to 1.27], P=0.18) was similar among groups. Among classic right ventricular echocardiographic indices, S prime and fractional area of change were lower among non-survivors, while still within normal range, while tricuspid annular plane systolic excursion was similar between groups. When exploring heterogeneity, we observed that removing outlier studies indicated consistently worse baseline right ventricular function among both strain and non-strain parameters.
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Conclusions
- Although right ventricular function appears to be worse among non-survivor ARDS patients, results vary due to high heterogeneity among published studies. The role of right ventricular speckle tracking echocardiography as a non-invasive bedside means of quantifying myocardial dysfunction and predicting patient outcomes remains to be explored further in future trials.
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Key Words: acute respiratory distress syndrome; intensive care unit; mechanical ventilation; right ventricular dysfunction; speckle tracking echocardiography
INTRODUCTION
Evaluation of right ventricular function is an integral part of acute respiratory distress syndrome (ARDS) assessment, given the multitude of pathophysiologic processes affecting the right side of the heart in this subset of critically-ill patients [1]. While cardiac magnetic resonance imaging is considered the gold standard, its implementation in point-of-care patient management is limited by availability and lack of relevant expertise, deeming bedside echocardiography a far more easily applicable alternative, especially in unstable patients [2].
Conventional echocardiographic indices of the right heart are subject to geometric limitations and ought to be evaluated in combination. Contrastingly, two-dimensional speckle tracking echocardiography (2D-STE) is an angle-independent and less load-dependent measure that provides a more global right cardiac functional assessment [3]. While use of deformation imaging has not been widely implemented due to a lack of technical standardization and normal limits definition as well between-vendors software differences in image post-processing, a recent joint consensus of societies of cardiovascular imaging aimed to amend those limitations [4].
Although the feasibility of STE and its diagnostic accuracy compared to conventional right cardiac echocardiographic indices (tricuspid annular plane systolic excursion [TAPSE], S prime [S’], right ventricular fractional area of change [RV FAC]) has already been confirmed in current series with mechanically ventilated patients, its utility and potential implementation for patient management remains to be confirmed by larger scale randomized clinical trials [5-10]. To further investigate the role of right ventricular echocardiography in ARDS, we conducted a meta-analysis of available studies to investigate the relationships between right-ventricular global and free-wall strain and mortality in ARDS patients.
MATERIALS AND METHODS
This study is based on previously published research and does not involve new human or animal subjects. Therefore, ethical approval and informed consent were not required. This systematic review and meta-analysis was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [11]. The protocol was registered in the PROSPERO international prospective register of systematic reviews (CRD42022299496).
Search Strategy
We explored all available published clinical studies from January 1, 2000 to May 5, 2025, using a search strategy designed by 2 authors (EX and DK). A comprehensive initial search was employed in PubMed (Medline) with the search phrase ("intub*" OR "ventilat*" OR “acute respiratory distress syndrome” OR “ARDS”) AND (“speckle tracking" OR “strain”) AND “echo*”. Two authors (EX and DEK) independently conducted the literature search. A grey literature search was also conducted (i.e., preprint servers, such as medRxiv and Research Square) for all articles containing any of the aforementioned terms. The last literature search was performed as defined in the search protocol on May 4, 2025.
Study Selection
All studies reporting measurements of right ventricular strain as measured by speckle tracking echocardiography and data on all-cause mortality of intubated patients with ARDS, as defined by the Berlin definition [12], were considered for inclusion. Case reports and case series involving less than five patients were excluded. We meticulously avoided double-counting overlapping patient populations and thus, any eligible cohorts that potentially overlapped with a latter study performed in the same medical facility by the same lead researcher were excluded.
Data Extraction
The titles, abstracts, and full texts of studies obtained using the search strategy and those from additional sources were independently screened by two review authors (EX and DEK) to identify studies that potentially met the inclusion criteria outlined above. Disagreements over the eligibility of studies were resolved through discussion among all authors.
A standardized proforma was used to extract data from the included studies, enabling the assessment of study quality and evidence synthesis. Extracted information included publication details (author, year), study characteristics, number of critically ill patients with ARDS and of those number of survivors and non-survivors, hardware for echocardiography, software by which off-line echocardiographic measurements were performed, echocardiographic parameters including (right ventricular strain [global and free-wall], TAPSE, S’, RV FAC) for both survivors and non-survivors, and patients’ clinical characteristics (severity of disease and comorbidities such as diabetes mellitus, hypertension, ischemic cardiac disease). When not directly provided, we calculated data of interest, i.e., by transforming continuous values to the form of mean and standard deviation, as described by the Cochrane Handbook version 6.5, 2024 [13]. The authors of studies with missing data were contacted to clarify and/or obtain the relevant data.
Assessment of Methodological Quality
Two authors (EX and DEK) independently assessed the risk of bias of included studies. Any disagreements were discussed with other authors. For risk of bias assessment, we modified and used the Tool to Assess Risk of Bias in Cohort Studies, developed by the CLARITY Group at McMaster University [14]. Details are provided in the Supplementary Material.
Statistical and Sensitivity Analysis
All statistical analyses were performed with Review Manager 5.4 (RevMan 5.4.1, Cochrane Collaboration) [15]. Continuous effect measures were summarized as mean difference (MD) with 95% CI. Continuous values were converted from medians to means, and interquartile range to standard deviation, following the Cochrane Guidelines [13]. A random effects model was conservatively utilized [13]. For the primary outcomes (right ventricular strain, global and free wall), we also confirmed our results using the even more conservative Hartung-Knapp-Sidik-Jonkman model [16]. A P-value less than 0.05 was considered statistically significant.
For all echocardiographic outcomes, only patients with available echocardiographic measurements were considered eligible for quantitative synthesis. When studies reported echocardiographic parameters stratified by survival status but did not explicitly specify the number of survivors and non-survivors within the analyzable echocardiographic subset, uncertainty in subgroup allocation was addressed through sensitivity analyses using alternative plausible allocation scenarios.
Heterogeneity was quantified using I2 and interpreted according to the Cochrane Guidelines; 0%–40%: low; 30%–60%: moderate; 50%–90%: substantial; 75%–100%: high [13]. To investigate heterogeneity, a pre-specified sensitivity analysis was performed for studies with a low risk of bias and a leave-one-out analysis was conducted to identify sources of high heterogeneity. We were unable to carry out the pre-specified sensitivity analysis by including only randomized controlled trials due to the lack of such studies.
RESULTS
Altogether, 228 relevant citations were identified and screened. In total, data extraction was feasible in six clinical studies resulting in a total population of 359 individuals who underwent speckle tracking echocardiography of the right heart (Figure 1) [5-10]. One study was excluded because overlapping of study patient populations with a repeat study by the same author could not be safely ruled out [8,17]. Table 1 shows the characteristics of ARDS patient populations in the included studies [5-10].
Data synthesis
Primary Outcomes: Right Ventricular Global Longitudinal Strain and Free-Wall Strain
Right ventricular global longitudinal strain of intubated ARDS patients was increased among non-survivors (lower values signify increased myocardial strain), as depicted in Figure 2 (MD [95% CI], –2.30 [–4.13 to –0.47], P=0.01; 3 studies, 144 patients). This result did not persist when we used the more conservative Hartung-Knapp-Sidik-Jonkman model (MD [95% CI], – 2.30 [–5.78 to 1.18]; P=0.104). Right ventricular free-wall strain of intubated ARDS patients was similar among survivors and non-survivors (lower values signify increased myocardial strain), as depicted in Figure 3 (MD [95% CI], –2.78 [–6.83 to 1.27]; P=0.18; 6 studies, 289 patients).
Secondary Outcomes
Among intubated patients with ARDS, TAPSE was similar in both groups (MD [95% CI], –2.15 [–4.87 to 0.57]; P=0.12; 6 studies, 307 patients), while S’ (MD [95% CI], –2.16 [–3.97 to –0.35]; P=0.02; 6 studies; 310 patients) and FAC (MD [95% CI], –1.49 [–2.05 to –0.93], P<0.00001; 5 studies, 280 patients) were lower among non-survivors (Figures 4-6).
Sensitivity analysis
The risk of bias assessment is presented in the Supplementary Material and Supplementary Table 1). All results of the primary and secondary outcomes persisted in the sensitivity analysis among low risk of bias studies. The results are presented in detail in Supplementary Figures 1-5.
Several outcomes exhibited substantial to considerable statistical heterogeneity. To explore the potential sources of heterogeneity, a leave-one-out sensitivity analysis was performed for outcomes with an I² ≥50%, specifically right ventricular free-wall strain, TAPSE, and S’. Through this analysis, we identified Tsolaki et al. [10] as an outlier contributing to heterogeneity in both RVFWS and TAPSE measurements. Removal of this study led to a marked reduction in heterogeneity (I2 reduction of 41 and 17%, respectively) and a more consistent effect estimate across the remaining studies, showing statistically significant differences of both RVFWS and TAPSE between the two groups, with non-survivors having worse baseline right ventricular function.
For S’, Liu et al. [5] was identified as the main contributor to heterogeneity. Exclusion of this dataset significantly attenuated inter-study variability and yielded more homogeneous results (I2 reduction of 90%) without altering the statistical significance of the result. Across the included studies, a total of three patients lacked analyzable echocardiographic data (two patients in Bonizzoli et al. [9] and one patient in Lemarié et al. [6]). In both studies, echocardiographic parameters were reported stratified by survival status, however, the original publications did not specify whether patients without analyzable echocardiographic data were survivors or non-survivors. Consequently, the exact allocation of missing echocardiographic data to survival status could not be determined.
To account for this uncertainty, meta-analyses were repeated under predefined extreme-case and proportionate allocation scenarios, assuming that missing echocardiographic data were attributable to (1) non-survivors only, (2) survivors only, or (3) proportionate to the overall survival distribution of the respective study cohort. Across all scenarios, pooled effect estimates remained numerically and directionally consistent, with overlapping confidence intervals and unchanged statistical significance. Given this stability, the primary analyses retained the originally reported subgroup sizes to avoid unnecessary loss of statistical power while transparently demonstrating robustness to plausible uncertainty in subgroup allocation.
DISCUSSION
In this systematic review and meta-analysis, we found that right ventricular global longitudinal strain is significantly increased among non-surviving, intubated patients with ARDS, while right ventricular free wall strain showed a non-significant trend in the same direction. This finding was independent of the geo-economic variation of the included studies and persisted in sensitivity analyses restricted to studies with low risk of bias. These findings highlight the promising role of right ventricular speckle tracking echocardiography as a bedside tool to help in the diagnostic work-up and predict the risk of hospital death of patients with ARDS. When interpreting the pooled estimates, it should be considered that while free wall strain was reported in all included studies, only three studies reported RV global longitudinal strain in a format suitable for quantitative synthesis.
Several experts have identified speckle-tracking myocardial strain and strain rate as research questions and important fields of interest in the assessment of heart–lung interactions [18]. The findings of the present systematic review and meta-analysis are in agreement with those of individual studies, supporting that deformation imaging can detect subtler myocardial functional decline than traditional echocardiographic measurements in critically ill patients with ARDS.
Our results indicate RV-2D-STE as a promising tool for bedside functional assessment of the right ventricle in this population. The accumulated evidence from relevant cohorts showed that right cardiac strain measured by speckle tracking echocardiography is increased among non-surviving ARDS patients. Although mean S′ and FAC values in both survivors and non-survivors were generally within conventionally defined normal ranges, non-survivors consistently exhibited lower RV systolic indices across studies, while TAPSE showed a non-significant trend. We hypothesize that these results stem from a combination two main factors: (1) an etiological, unmodifiable relationship between baseline myocardial function and outcomes, i.e., patients with inherently worse right ventricular function at baseline have reduced survival in the course of the disease, independent of therapeutic measures, and (2) suboptimal ventilation parameters that did not alleviate right ventricular stress during the evolving course of cardiopulmonary failure, allowing for increasing pulmonary vascular resistance to lead to acute cor pulmonale (ACP) and circulatory failure.
It has been long acknowledged that suboptimal mechanical ventilation can severely impact right ventricular function due to increased pleural and transpulmonary pressure secondary to high positive end-expiratory pressure values and tidal forces as well as pulmonary vasoconstriction in hypoxic/hypercapnic states [19,20]. In patients with ARDS, application of RV-protective mechanical ventilation consisting of low driving pressures, normocapnia and PEEP titration according to lung recruitability are key to preventing cardiac failure and improving survival [20]. Despite the benefits of lung-protective ventilation, ACP remains highly prevalent among ARDS patients. Therefore, timely identification and treatment are crucial for improving outcomes and specific algorithms based on daily echocardiographic monitoring of the RV have been proposed [20].
The modest differences in conventional RV measurements, which are frequently within normal reference ranges, indicate that overt RV systolic failure was uncommon in the included cohorts. These findings suggest that subtle impairments in RV performance, rather than severe dysfunction, are associated with mortality in ARDS or that these parameters cannot consistently capture clinically relevant results. Such subclinical changes may reflect early RV-pulmonary vascular uncoupling or reduced physiological reserve under conditions of increased pulmonary vascular load and mechanical ventilation. In contrast to conventional indices, RV strain parameters, where available, demonstrated more clinically meaningful separation between survivors and non-survivors, with values in non-survivors more frequently falling within pathological ranges. This observation is consistent with the higher sensitivity of myocardial deformation imaging for detecting early or subclinical RV dysfunction and supports the potential incremental prognostic value of RV strain in ARDS.
Our results suggest that the need for a daily extensive echocardiographic study is overstated and replacing traditional right-cardiac measurements with strain calculation is viable. In 2D-STE, the movement of the acoustic backscatters from ultrasound wave-myocardial interaction termed “speckles” is followed throughout the cardiac cycle, much similar to the principles behind the gold-standard of right ventricular functional quantification that is cardiac magnetic resonance imaging. In contrast, conventional RV markers examine myocardial function in specific anatomic structures and movement planes and therefore cannot provide such “global” oversight of overall ventricular behavior. Combining this information with the fact that RV strain can be measured from a single echocardiographic plane (RV focused 4-chamber view) and off-line analysis performed in a semi-automated manner by newly available software plugins, further reducing interobserver variation in imaging analysis, the theoretical benefit of this method becomes evident. Further research should investigate right ventricular global longitudinal and free wall strain in different phenotypes, e.g., right ventricular dilation or right ventricular dilation with impaired systolic function.
Interestingly, substantial heterogeneity was observed in the results for RVFWS, TAPSE, and S’. A leave-one-out sensitivity analysis identified individual studies (Tsolaki et al. [10] for RVFWS and TAPSE, Liu et al. [5] for S’) as key contributors to the observed heterogeneity. Exclusion of these outlier studies not only reduced statistical heterogeneity markedly but also resulted in statistically significant differences in RVFWS and TAPSE between survivors and non-survivors. This suggests that baseline RV dysfunction is more strongly associated with mortality than initially indicated.
The complete analysis, including Tsolaki et al. [10], suggested no clear differences in baseline strain values between survivors and non-survivors. This might be due to cohort-specific factors such as disease severity, measurement timing, or patient phenotype. Importantly, mechanical ventilation settings and respiratory system mechanics were not uniformly reported across studies, limiting our ability to assess the impact of ventilatory factors on strain values. Many included studies enrolled patients with coronavirus disease 2019 (COVID-19)-related ARDS, where RV dysfunction may reflect evolving microvascular injury and increased pulmonary vascular resistance due to thrombotic events. In this context, early strain measurements shortly after intubation may fail to capture the disease's progressive hemodynamic burden. Tsolaki et al. [10] indeed showed no difference at baseline, but a follow-up after 10 days demonstrated a trend toward worsening RV strain in non-survivors, supporting the concept of dynamic RV dysfunction in ARDS.
Another reason for the discrepancy between the global and free-wall strain measurements it that the assessment of global RV myocardial deformation is thought to better describe RV function in high-afterload states such as ARDS, due to ventricular interdependence. In physiologic states, left ventricular contraction contributes up to 40% of RV systolic pressure and outflow, with that percentage being increased in high-afterload states, as a result of geometric conformational changes during the interventricular wall contraction [6]. In accordance, our findings suggest that free-wall strain alone may not sufficiently differentiate patient outcomes in all ARDS cohorts, underlining the importance of global strain assessment or the identification of confounding factors (e.g., mechanical ventilation parameters) that should be taken into account for a more precise baseline assessment.
This study has limitations. First, our meta-analysis comprised a small number of studies due to lack of relevant literature. This is to be expected, as the implementation of right cardiac speckle tracking echocardiography in clinical practice is recent and ongoing. To address the potential type I error rates by the DerSimonian and Laird approach for the random effect meta-analysis we repeated our main analysis using the even more conservative Hartung-Knapp-Sidik-Jonkman model. This adjustment affected the statistical significance for global strain, but not for other parameters, indicating that these results must be interpreted with caution. Second, the inclusion of small non-adjusted for other prognostic factors cohorts increases the risk of bias for the analysis results. To address this limitation, we performed prespecified sensitivity analyses including only studies with low risk of bias, and further solidified our initial findings. Third, right ventricular strain measured by different probes and software packages is a potential source of severe interobserver variation in patient echocardiographic assessment. In order to provide the reader with a better understanding of how the measurements included in this meta-analysis were made, we clarified the types of echocardiographic equipment and vendor software used in a descriptive table. Moreover, echocardiographic parameters were largely unadjusted for global illness severity scores such as Sequential Organ Failure Assessment (SOFA) or Acute Physiology and Chronic Health Evaluation (APACHE) II, and residual confounding by ARDS severity cannot be excluded. Consequently, the observed associations should be interpreted as hypothesis-generating rather than causal. Right ventricular functional abnormalities may therefore represent incidental (“bystander”) findings that reflect greater overall disease severity with accompanying myocardial dysfunction, rather than an independent causal determinant of mortality. This limitation could not be addressed in the present study but warrants further investigation in future, adequately adjusted studies.
The results of this systematic review and meta-analysis indicate that right ventricular global longitudinal strain is significantly increased among non-surviving ARDS patients, while free-wall strain did not differ significantly between groups. Exploring the individual studies revealed a potential role for longitudinal measurements after ARDS establishment as a tool for more accurate point-of-care monitoring and outcome assessment. These findings support the potential role of right ventricular speckle tracking echocardiography as a non-invasive bedside tool for assessing myocardial dysfunction and stratifying risk in ARDS, but also reveal a current gap in knowledge regarding potential confounding factors (most importantly, disease severity) that could aid clinicians in optimizing assessments. Future studies should further explore the clinical utility of right ventricular speckle tracking echocardiography, particularly in longitudinal monitoring and in relation to ventilatory and disease-specific factors.
KEY MESSAGES
A meta-analysis of current available data on right ventricular speckle tracking echocardiography showed increased right ventricular-strain among non survivors, a marker that could be used on the bedside as an early predictor of disease outcome.
NOTES
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CONFLICT OF INTEREST
No potential conflict of interest relevant to this article was reported.
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FUNDING
None.
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ACKNOWLEDGMENTS
We gratefully thank Francesca Bursi for showing praise-worthy academic attitude and generously providing us with additional data and/or clarifications regarding her studies.
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AUTHOR CONTRIBUTIONS
Conceptualization: EX, DEK. Methodology: EX. Formal analysis: EX, DEK. Data curation: EX. Project administration: EX, IIS, AK, CR. Writing - original draft: EX. Writing - review & editing: IIS, AK, CR. All authors read and agreed to the published version of the manuscript.
SUPPLEMENTARY MATERIALS
Supplementary materials can be found via https://doi.org/10.4266/acc.006025.
Supplementary Figure 1.
Right ventricular global longitudinal strain of intubated patients with acute respiratory distress syndrome between non-survivors and survivors. Mean difference and 95% CI were calculated using a random effects model. SD: standard deviation; IV: inverse variance method.
acc-006025-Supplementary-Figure-1.pdf
Supplementary Figure 2.
Right ventricular free wall strain of intubated patients with acute respiratory distress syndrome between non-survivors and survivors. Mean difference and 95% CI were calculated using a random effects model. SD: standard deviation; IV: inverse variance method.
acc-006025-Supplementary-Figure-2.pdf
Supplementary Figure 3.
Tricuspid annular plane systolic excursion of intubated patients with acute respiratory distress syndrome between non-survivors and survivors. Mean difference and 95% CI were calculated using a random effects model. SD: standard deviation; IV: inverse variance method.
acc-006025-Supplementary-Figure-3.pdf
Supplementary Figure 4.
S prime of intubated patients with acute respiratory distress syndrome between non-survivors and survivors. Mean difference and 95% CI were calculated using a random effects model. SD: standard deviation; IV: inverse variance method.
acc-006025-Supplementary-Figure-4.pdf
Supplementary Figure 5.
Fractional area change of intubated patients with ARDS between non-survivors and survivors. Mean difference and 95% CI were calculated using a random effects model.
acc-006025-Supplementary-Figure-5.pdf
Figure 1.Study flowchart.
Figure 2.Right ventricular global longitudinal strain of intubated patients with acute respiratory distress syndrome between non-survivors and survivors. Mean difference and 95% CI were calculated using a random effects model. SD: standard deviation; IV: inverse variance method.
Figure 3.Right ventricular free wall strain of intubated patients with acute respiratory distress syndrome between non-survivors and survivors. Mean difference and 95% CI were calculated using a random effects model. SD: standard deviation; IV: inverse variance method.
Figure 4.Tricuspid annular plane systolic excursion of intubated patients with acute respiratory distress syndrome between non-survivors and survivors. Mean difference and 95% CI were calculated using a random effects model. SD: standard deviation; IV: inverse variance method.
Figure 5.S prime of intubated patients with acute respiratory distress syndrome between non-survivors and survivors. Mean difference and 95% CI were calculated using a random effects model. SD: standard deviation; IV: inverse variance method.
Figure 6.Fractional area change of intubated patients with acute respiratory distress syndrome between non-survivors and survivors. Mean difference and 95% CI were calculated using a random effects model. SD: standard deviation; IV: inverse variance method.
Table 1.Characteristics of individual studies and study populations included in the meta-analysis
|
Study |
Year |
Country |
Type of study |
Echo type |
ARDS cohort |
Etiology (main) |
Survivor (n) |
Disease severity score (survivor) |
Age (survivor) |
Female (survivor, %) |
Non-survivor (n) |
Disease severity score (non-survivor) |
Age (non-survivor) |
Female (non-survivor, %) |
|
Bonizzoli et al. [9] |
2018 |
Italy |
Observational prospective |
Esaote MyLab 30Gold Cardiovascular (Vivid I, GE). |
30 (28 with echo data) |
76% Lung infection (bacterial) |
20 |
SAPS II, 34.7±8.8 |
55.8±14 |
45 |
10 |
SAPS II, 60.3±9.6 |
62.4±12.5 |
50 |
|
Lemarié et al. [6] |
2020 |
France |
Observational prospective |
Vivid S6 echocardiograph (GE Medical Systems) & (EchoPAC version 201, GE Vingmed Ultrasound AS) |
48 (47 with echo data) |
67% Lung Infection (bacterial) |
36 |
SOFA, 8±2.9 |
58 ± 17 |
38.9 |
12 |
SOFA, 10±4.4 |
68 ± 14 |
58.3 |
|
Liu et al. [5] |
2020 |
China |
Observational prospective |
Venue S12 echocardiograph (GE Medical Systems & Tom‐Tec software (Image‐Arena, Tom‐Tec imaging system) |
43 |
100% Lung infection (viral) |
21 |
NA |
64.1±9.8 |
66.6 |
22 |
NA |
64.9±10.4 |
31.8 |
|
Bursi et al. [8] |
2022 |
Italy |
Observational retrospective |
Vivid S6 echocardiograph (GE Medical Systems) & (EchoPAC version 201, GE Vingmed Ultrasound AS) |
53 |
100% Lung infection (viral) |
34 |
NA |
NA |
NA |
19 |
NA |
NA |
NA |
|
Temperikidis et al. [7] |
2022 |
Greece |
Observational prospective |
Vivid E9 echocardiograph (GE Medical Systems) & (EchoPAC version 204, GE Vingmed Ultrasound AS) |
9 |
100% Lung infection (viral) |
4 |
SOFA, 6.7±1.7 |
65.2±5.1 |
25 |
5 |
SOFA, 8.1±1.2 |
60.4±18.7 |
20 |
|
Tsolaki et al. [10] |
2024 |
Greece |
Observational prospective |
Vivid E95, (GE Medical Systems, USA-Philips iE33, Philips Medical) |
176 |
100% Lung infection (viral) |
56 |
SOFA, 7.5±0.2 |
65.9±1.5 |
30.4 |
120 |
SOFA, 8.0±0.2 |
67.4±1.0 |
33.3 |
REFERENCES
- 1. Zochios V, Parhar K, Tunnicliffe W, Roscoe A, Gao F. The right ventricle in ARDS. Chest 2017;152:181-93.ArticlePubMed
- 2. Soliman-Aboumarie H, Joshi SS, Cameli M, Michalski B, Manka R, Haugaa K, et al. EACVI survey on the multi-modality imaging assessment of the right heart. Eur Heart J Cardiovasc Imaging 2022;23:1417-22.ArticlePubMedPDF
- 3. Zaidi A, Knight DS, Augustine DX, Harkness A, Oxborough D, Pearce K, et al. Echocardiographic assessment of the right heart in adults: a practical guideline from the British Society of Echocardiography. Echo Res Pract 2020;7:G19-41.ArticlePubMedPMCPDF
- 4. Badano LP, Kolias TJ, Muraru D, Abraham TP, Aurigemma G, Edvardsen T, et al. Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging 2018;19:591-600.ArticlePubMed
- 5. Liu Y, Xie J, Gao P, Tian R, Qian H, Guo F, et al. Swollen heart in COVID-19 patients who progress to critical illness: a perspective from echo-cardiologists. ESC Heart Fail 2020;7:3621-32.ArticlePubMedPMCPDF
- 6. Lemarié J, Maigrat CH, Kimmoun A, Dumont N, Bollaert PE, Selton-Suty C, et al. Feasibility, reproducibility and diagnostic usefulness of right ventricular strain by 2-dimensional speckle-tracking echocardiography in ARDS patients: the ARD strain study. Ann Intensive Care 2020;10:24.ArticlePubMedPMC
- 7. Temperikidis P, Koroneos A, Xourgia E, Kotanidou A, Siempos II. Abnormal right ventricular free wall strain prior to prone ventilation may be associated with worse outcome of patients with COVID-19-associated acute respiratory distress syndrome. Crit Care Explor 2022;4:e0620. ArticlePubMedPMC
- 8. Bursi F, Santangelo G, Barbieri A, Vella AM, Toriello F, Valli F, et al. Impact of right ventricular-pulmonary circulation coupling on mortality in SARS-CoV-2 infection. J Am Heart Assoc 2022;11:e023220. ArticlePubMedPMC
- 9. Bonizzoli M, Cipani S, Lazzeri C, Chiostri M, Ballo P, Sarti A, et al. Speckle tracking echocardiography and right ventricle dysfunction in acute respiratory distress syndrome a pilot study. Echocardiography 2018;35:1982-7.ArticlePubMedPDF
- 10. Tsolaki V, Zakynthinos GE, Karavidas N, Vazgiourakis V, Papanikolaou J, Parisi K, et al. Comprehensive temporal analysis of right ventricular function and pulmonary haemodynamics in mechanically ventilated COVID-19 ARDS patients. Ann Intensive Care 2024;14:25.ArticlePubMedPMCPDF
- 11. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009;339:b2700.ArticlePubMedPMC
- 12. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012;307:2526-33.ArticlePubMed
- 13. Higgins J, Thomas J, Chandler J, Cumpston M, Li M, Page M, et al. Cochrane handbook for systematic reviews of interventions version 6.5 (updated August 2024) [Internet]. Cochrane 2024 [cited 2026 Mar 7]. Available from: https://www.cochrane.org/authors/handbooks-and-manuals/handbook
- 14. CLARITY Group, McMaster University. Tool to assess risk of Bias in case-control studies. McMaster University.
- 15. The Cochrane Collaboration. Review Manager (RevMan). Version 5.4.1. The Cochrane Collaboration; 2020.
- 16. IntHout J, Ioannidis JP, Borm GF. The Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis is straightforward and considerably outperforms the standard DerSimonian-Laird method. BMC Med Res Methodol 2014;14:25.ArticlePubMedPMCPDF
- 17. Bursi F, Santangelo G, Sansalone D, Valli F, Vella AM, Toriello F, et al. Prognostic utility of quantitative offline 2D-echocardiography in hospitalized patients with COVID-19 disease. Echocardiography 2020;37:2029-39.ArticlePubMedPMCPDF
- 18. Mayo P, Arntfield R, Balik M, Kory P, Mathis G, Schmidt G, et al. The ICM research agenda on critical care ultrasonography. Intensive Care Med 2017;43:1257-69.ArticlePubMedPDF
- 19. Yamamoto Y, Nakano H, Ide H, Ogasa T, Takahashi T, Osanai S, et al. Role of airway nitric oxide on the regulation of pulmonary circulation by carbon dioxide. J Appl Physiol (1985) 2001;91:1121-30.ArticlePubMed
- 20. Vieillard-Baron A, Matthay M, Teboul JL, Bein T, Schultz M, Magder S, et al. Experts' opinion on management of hemodynamics in ARDS patients: focus on the effects of mechanical ventilation. Intensive Care Med 2016;42:739-49.ArticlePubMedPDF
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