Table 10Clinical evidence summary: Right ventricular function on cardiac MRI

Risk factor and outcome

(population)

Number of studiesEffect (95% CI)Risk of biasImprecisionIndirectnessGRADE Quality
Cardiac death following TR surgery

RVEF per 5% higher (continuous variable) on cardiac MRI for predicting cardiac death following TR surgery – follow-up median 57 months

(severe isolated functional TR undergoing TR surgery, 54.7% in NYHA class III/IV; mean age 59.3 years)

1 (n=75)Adjusted HR 0.71 (0.53 to 0.97) aVery seriousbNoneSeriouscVERY LOW

RVEF <46% vs ≥46% on cardiac MRI for predicting cardiac death following TR surgery – follow-up median 57 months (unadjusted HR estimated from data provided)

(severe isolated functional TR undergoing TR surgery, 54.7% in NYHA class III/IV; mean age 59.3 years)

1 (n=75)Unadjusted HR 5.06 (1.56 to 16.46) dVery seriousbNoneSeriouscVERY LOW

RV-ESVI per 10 ml/m2 increase (continuous variable) on cardiac MRI for predicting cardiac death following TR surgery – follow-up median 57 months

(severe isolated functional TR undergoing TR surgery, 54.7% in NYHA class III/IV; mean age 59.3 years)

1 (n=75)Adjusted HR 1.18 (1.03 to 1.37) aVery seriousbNoneSeriouscVERY LOW

RV-ESVI ≥76 ml/m2 vs. <76 ml/m2 on cardiac MRI for predicting cardiac death following TR surgery – follow-up median 57 months (unadjusted HR estimated from data provided)

(severe isolated functional TR undergoing TR surgery, 54.7% in NYHA class III/IV; mean age 59.3 years)

1 (n=75)Unadjusted HR 0.29 (0.09 to 0.91) dVery seriousbNoneSeriouscVERY LOW
Postoperative cardiac events (cardiac death or unplanned cardiac-related readmission)

RVEF per 5% higher (continuous variable) on cardiac MRI for predicting postoperative cardiac events (cardiac death or unplanned cardiac-related readmission) following TR surgery – follow-up median 57 months

(severe isolated functional TR undergoing TR surgery, 54.7% in NYHA class III/IV; mean age 59.3 years)

1 (n=75)Adjusted HR 0.8 (0.65 to 0.97)aVery seriousbNoneSeriouscVERY LOW

RVEF <46% vs ≥46% on cardiac MRI for predicting postoperative cardiac events (cardiac death or unplanned cardiac-related readmission) following TR surgery – follow-up median 57 months (unadjusted HR estimated from data provided)

(severe isolated functional TR undergoing TR surgery, 54.7% in NYHA class III/IV; mean age 59.3 years)

1 (n=75)Unadjusted HR 3.94 (1.59 to 9.76)dVery seriousbNoneSeriouscVERY LOW

RV-ESVI per 10 ml/m2 increase (continuous variable) on cardiac MRI for predicting postoperative cardiac events (cardiac death or unplanned cardiac-related readmission) following TR surgery – follow-up median 57 months

(severe isolated functional TR undergoing TR surgery, 54.7% in NYHA class III/IV; mean age 59.3 years)

1 (n=75)Adjusted HR 1.1 (1 to 1.22)aVery seriousbSeriouseSeriouscVERY LOW

RV-ESVI ≥76 ml/m2 vs. <76 ml/m2 on cardiac MRI for predicting postoperative cardiac events (cardiac death or unplanned cardiac-related readmission) following TR surgery – follow-up median 57 months (unadjusted HR estimated from data provided)

(severe isolated functional TR undergoing TR surgery, 54.7% in NYHA class III/IV; mean age 59.3 years)

1 (n=75)Unadjusted HR 0.46 (0.19 to 1.11)dVery seriousbSeriouseSeriouscVERY LOW
(a)

Methods: multivariable analysis, adjusted for age, sex, NYHA class, haemoglobin level and glomerular filtration rate

(b)

Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias

(c)

Population - all underwent intervention for severe functional TR so does not represent population where there is uncertainty about whether there is an indication for intervention; and outcome - only includes cardiac deaths and not all deaths.

(d)

Methods: no multivariable analysis, HR estimated from data provided in paper

(e)

95% CI crossed null line

From: Evidence review for CT and MRI indications for intervention

Cover of Evidence review for CT and MRI indications for intervention
Evidence review for CT and MRI indications for intervention: Heart valve disease presenting in adults: investigation and management: Evidence review F.
NICE Guideline, No. 208.
Copyright © NICE 2021.

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