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Background: Right ventricular failure (RVF) following left ventricular assist device (LVAD) implantation is associated with worse outcomes. Prediction of RVF is difficult with routine transthoracic echocardiography (TTE), while speckle‐tracking echocardiography (STE) showed promising results. We performed systematic review and meta‐analysis of published literature. Methods: We queried multiple databases to compile articles reporting preoperative or intraoperative right ventricle global longitudinal strain (RVGLS) or right ventricle free wall strain (RVFWS) in LVAD recipients. The standard mean difference (SMD) in RVGLS and RVFWS in patients with and without RVF postoperatively was pooled using random‐effects model. Results: Seventeen studies were included. Patients with RVF had significantly lower RVGLS and RVFWS as compared to non‐RVF patients; SMD: 2.79 (95% CI: −4.07 to −1.50; P: <.001) and −3.05 (95% CI: −4.11 to −1.99; P: <.001), respectively. The pooled odds ratio (OR) for RVF per percentage increase of RVGLS and RVFWS were 1.10 (95 CI: 0.98–1.25) and 1.63 (95% CI 1.07–2.47), respectively. In a subgroup analysis, TTE‐derived GLS and FWS were significantly lower in RVF patients as compared to non‐RVF patients; SMD of −3.97 (95% CI: −5.40 to −2.54; P: <.001) and −3.05 (95% CI: −4.11 to −1.99; P: <.001), respectively. There was no significant difference between RVF and non‐RVF groups in TEE‐derived RVGLS and RVFWS. Conclusion: RVGLS and RVFWS were lower in patients who developed RVF as compared to non‐RVF patients. In a subgroup analysis, TTE‐derived RVGLS and RVFWS were reduced in RVF patients as compared to non‐RVF patients. This difference was not reported with TEE. [ABSTRACT FROM AUTHOR]

Background: Dobutamine stress echocardiography (DSE) is a well‐established imaging modality used to screen patients with mild‐to‐moderate risk for coronary artery disease. In heart transplantation recipients, cardiac allograft vasculopathy (CAV) is a common and lethal complication. The use of DSE to detect CAV showed promising results initially, but later studies showed limitation in its use to detect CAV. It is unclear if this cohort of patients derives benefit from DSE. Methods: We searched PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Scopus from inception through March 2018 for studies examining the accuracy of DSE in correlation to coronary angiography (CA) or intravascular ultrasound (IVUS) to detect CAV. Original studies comparing the ability of DSE to detect CAV in comparison with CA or IVUS were included. Relevant data were extracted and hierarchical summary receiver operating characteristic analysis was conducted to test the overall diagnostic accuracy of DSE for patients with CAV. Results: Eleven studies (749 participants) met the inclusion criteria. The sensitivity of DSE varied from 1.7% to 93.8%, and specificity, from 54.8% to 98.8%. Pooled sensitivity was 60.2% (95% confidence interval (CI), 33.0%–82.3%) and specificity 85.7% (95% CI, 73.8%–92.7%). DSE had an overall diagnostic odds ratio (OR) of 9.1 (95% CI, 4.6–17.8), positive likelihood ratio (LR+) of 4.1 (95% CI, 2.8–6.1), negative likelihood ratio (LR−) of 0.47 (95% CI: 0.23–0.73), and area under curve (AUC) of 0.73 (95% CI, 0.72–0.75). Heterogeneity among studies was not statistically significant (τ2 = 0.32, Cochran's Q = 9.5, P = 0.483). Conclusion: Dobutamine stress echocardiography has a limited sensitivity to detect early CAV but its specificity is much higher. There remains a need for an alternative noninvasive modality which will have both high sensitivity and high specificity for detecting CAV. [ABSTRACT FROM AUTHOR]