Right Ventricular Strain and RV-Pulmonary Artery Coupling in Systemic Sclerosis: A Systematic Review.

Area of Science:

• Cardiology
• Rheumatology
• Medical Imaging

Background:

• Right ventricular (RV) dysfunction is a major cause of mortality in systemic sclerosis (SSc), driven by microvascular disease, fibrosis, and pulmonary hypertension.
• Conventional echocardiography often misses early RV impairment, necessitating advanced imaging techniques.
• Advanced RV imaging parameters like RV strain and RV-pulmonary artery (PA) coupling are gaining interest for their potential in early detection and prognostication.

Purpose of the Study:

• To systematically review and synthesize evidence on the role of RV strain and RV-PA coupling in systemic sclerosis (SSc).
• To evaluate the relationship between these advanced RV parameters, clinical outcomes, and biomarkers in SSc.
• To compare the diagnostic and prognostic utility of advanced RV assessment versus conventional echocardiography in SSc.

Main Methods:

• A systematic literature search was performed to identify studies evaluating RV strain (RV free-wall longitudinal strain [RV-FWS], global longitudinal strain [RV-GLS]) and RV-PA coupling in adult SSc patients.
• Eligible studies utilized speckle-tracking echocardiography or cardiac magnetic resonance feature-tracking.
• Data extraction and study selection followed PRISMA guidelines.

Main Results:

• Seven studies met the inclusion criteria.
• RV strain parameters (RV-FWS, RV-GLS) consistently detected subclinical RV impairment in SSc, even when conventional echocardiography showed normal findings.
• Strain-derived RV-PA coupling improved prognostic stratification in pulmonary arterial hypertension (PAH) models, and impaired RV deformation predicted mortality. Biomarker associations (e.g., NT-proBNP) with RV dysfunction were limited but suggested complementary information.

Conclusions:

• RV strain and RV-PA coupling indices are superior to conventional echocardiography for early detection, monitoring progression, and predicting adverse outcomes in SSc.
• While biomarker data are limited, natriuretic peptides may offer complementary prognostic information when integrated with strain assessments.
• Standardized prospective studies are needed to fully elucidate the combined diagnostic and prognostic value of advanced RV imaging and biomarkers in SSc.