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\begin{document}

\title{Assessment of Right Ventricular Function Following Left Ventricular
Assist Device Implantation -- The Role of Speckle-Tracking
Echocardiography: A Meta-Analysis.}



\author[1]{Kirolos Barssoum}%
\author[2]{Ahmed Altibi}%
\author[1]{Devesh Rai}%
\author[1]{Adnan Kharsa}%
\author[1]{Medhat Chowdhury}%
\author[3]{Ahmed Elkaryoni}%
\author[4]{Ahmed Abuzaid}%
\author[5]{Bipul Baibhav}%
\author[1]{Vishal Parikh}%
\author[1]{Mallory Balmer-Swain}%
\author[6]{Ahmad Masri}%
\author[7]{Myriam Amsallem}%
\author[8]{Navin C. Nanda}%
\affil[1]{Rochester General Hospital}%
\affil[2]{Henry Ford Allegiance Health}%
\affil[3]{Loyola University Medical Center}%
\affil[4]{Alaska Heart and Vascular Institute LLC}%
\affil[5]{Rochester Regional Health}%
\affil[6]{Oregon Health \& Science University}%
\affil[7]{Stanford University School of Medicine}%
\affil[8]{Affiliation not available}%


\vspace{-1em}



  
  \date{June 17, 2024}


\begingroup
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\selectlanguage{english}
\begin{abstract}
Background: Right ventricular failure (RVF) following Left Ventricular
Assist Device (LVAD) implantation is associated with worse outcomes.
Prediction and early identification of RVF with speckle-tracking
echocardiography (STE) has been proposed. Methods: We queried multiple
databases for articles reporting on pre-operative/intraoperative global
longitudinal strain (GLS) and free-wall strain (FWS) in LVAD recipients.
We performed a systematic review and meta-analysis of published
literature. The standard mean difference (SMD) in GLS and FWS in
patients with and without RVF postoperatively was pooled using random
effects model. Results: Fifteen studies, with a total of 967 LVAD
recipients were included. There was statistically significant difference
in GLS among patients who did and did not develop RVF; SMD= -3.09 (95\%
CI: -4.62 to -1.57; p-value \textless{}0.0001). There was significant
difference in FWS between two groups; SMD: -2.75 (95\% CI: -3.72 to
-1.79; p-value \textless{}0.0001). Upon subgroup analysis of imaging
modality, transthoracic echocardiography (TTE)-derived GLS and FWS
remained predictive for RVF with SMD of -3.97 (95\% CI: -5.40 to -2.54;
p-value \textless{}0.001) and -3.05 (95\% CI: -4.11 to -1.99; p-value
\textless{}0.001), respectively. However, there was no significant
difference between RVF and non-RVF groups upon using transesophageal
echocardiography (TEE) to assess GLS and FWS. Conclusion: GLS and FWS
assessment of the RV by STE is a useful tool to predict postoperative
RVF in LVAD recipients. While the predictive role of TTE was robust, the
TEE-derived measures seemed to be less predictive. Future studies need
to specify the strain cut-off value that can predict the adverse outcome
of RVF%
\end{abstract}%



\sloppy


\textbf{ABSTRACT}

\textbf{Background:} Right ventricular failure (RVF) following Left
Ventricular Assist Device (LVAD) implantation is associated with worse
outcomes. Prediction and early identification of RVF with
speckle-tracking echocardiography (STE) has been proposed.

\textbf{Methods:} We queried multiple databases for articles reporting
on pre-operative/intraoperative global longitudinal strain (GLS) and
free-wall strain (FWS) in LVAD recipients. We performed a systematic
review and meta-analysis of published literature. The standard mean
difference (SMD) in GLS and FWS in patients with and without RVF
postoperatively was pooled using random effects model.

\textbf{Results:} Fifteen studies, with a total of 967 LVAD recipients
were included. There was statistically significant difference in GLS
among patients who did and did not develop RVF; SMD= -3.09 (95\% CI:
-4.62 to -1.57; p-value \textless{}0.0001). There was significant
difference in FWS between two groups; SMD: -2.75 (95\% CI: -3.72 to
-1.79; p-value \textless{}0.0001). Upon subgroup analysis of imaging
modality, transthoracic echocardiography (TTE)-derived GLS and FWS
remained predictive for RVF with SMD of -3.97 (95\% CI: -5.40 to -2.54;
p-value \textless{}0.001) and -3.05 (95\% CI: -4.11 to -1.99; p-value
\textless{}0.001), respectively. However, there was no significant
difference between RVF and non-RVF groups upon using transesophageal
echocardiography (TEE) to assess GLS and FWS.

\textbf{Conclusion:} GLS and FWS assessment of the RV by STE is a useful
tool to predict postoperative RVF in LVAD recipients. While the
predictive role of TTE was robust, the TEE-derived measures seemed to be
less predictive. Future studies need to specify the strain cut-off value
that can predict the adverse outcome of RVF.

\textbf{INTRODUCTION}

In the year 2019, there was 9,000 LVAD implanted across the globe as an
established therapy for patients with advanced heart failure (HF). With
the comparable mortality outcomes to heart transplantation and the
shortage of donor organs, the use of LVAD is projected to continue to
increase.\textsuperscript{1} Right ventricular failure (RVF) is a common
complication following LVAD implantation that complicates 20--25\% of
cases and associated with increased morbidity and mortality
postoperatively.\textsuperscript{2} Proposed mechanisms for RVF suggest
acute increase in right-sided preload due to improved left ventricular
output, leading to stretching of the right ventricular wall with
subsequent functional tricuspid regurgitation, and ultimately decreased
right ventricular output.\textsuperscript{2} Studies have demonstrated
that early prediction of RVF and timely intervention often with
biventricular mechanical support (BiVAD) confer favorable
outcomes.\textsuperscript{3} Hence, several predictive risk scores were
modeled to assess the risk of RVF among LVAD
recepients.\textsuperscript{4--7} However, the performance of these
predictive scores had not been consistent across
studies\textsuperscript{6,7} and their validity had not been well-
established in continuous flow LVAD.\textsuperscript{4,5}

The complexity of right ventricle (RV) anatomy and its location in the
chest obscure the ability to obtain detailed anatomical and functional
evaluation in every patient.\textsuperscript{2} While the longitudinal
shortening of the RV can be estimated by assessing the tricuspid annular
plane systolic excursion (TAPSE), its discriminatory ability to predict
RVF has been heterogeneous among studies.\textsuperscript{5} Speckle
tracking echocardiography (STE) is a novel imaging modality which
demonstrates promising results in predicting RVF after LVAD
implantation.\textsuperscript{8} The Region of Interest (ROI) is
delineated by speckles and followed through the cardiac
cycle.\textsuperscript{9,10} Correlation has been well-demonstrated with
RV ejection fraction as measured by cardiac magnetic resonance
(CMR).\textsuperscript{11,12} RV assessment by STE can be either for the
entire RV, including the interventricular septum, or limited to the RV
free wall -- which is considered a more focused and less biased
assessment. Most published reports included small samples size, but with
an overall common shared approach. To our knowledge, only one prior
meta-analysis has evaluated the utility of RV strain in predicting RVF;
the analysis only included three studies and was limited to TTE-derived
FWS.\textsuperscript{13} Thus, we performed a systematic review and
meta-analysis of published studies that investigated the role of STE and
longitudinal RV strain in predicting RVF following LVAD implantation.

2. \textbf{METHODS}

\textbf{Search Strategy}

Our study protocol followed the recommendation of the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
statement.\textsuperscript{14} We conducted an electronic search of the
literature to identify publications reporting on the predictive role of
STE in post-operative RVF among LVAD recipients. Systematic search was
conducted using the following databases: MEDLINE, EmCare, CINAHL,
Cochrane Database, and Google Scholar. The following keywords and search
terms were used: (``echocardiography'' AND ``left ventricular assist
device OR LVAD'' AND ``speckle-tracking echocardiography'', AND ``right
ventricle''). Search results were limited to articles published in the
English language.

\textbf{Study Selection and Data Extraction}

To be eligible for inclusion, studies should be (i) reporting on adult
patients [?]18 years of age undergoing LVAD implantation, (ii) reporting
on the occurrence of RVF, and (iii) reporting on preoperative and/or
intraoperative two-dimensional echocardiography -- with report on GLS
and/or FWS. RVF was defined as the need for right ventricular assist
device (RVAD), central venous pressure (CVP) \textgreater{}16 mmHg,
cardiac index \textless{}2.3 L/min/m\textsuperscript{2}, or the need for
post-operative ionotropic support.\textsuperscript{36} We excluded case
reports, review articles, editorials, and correspondences to the editor.
Studies and those which did not include GLS and/or FWS or did not report
post-operative right ventricular function were excluded. Data was
extracted by two independent investigators K.B. and M.C. into a
predefined collection sheet. All disagreements were resolved in
consensus with a third reviewer (D.R.). Extracted data included baseline
characteristics, definition of RVF, occurrence of RVF, GLS, and FWS.

\textbf{Quality Assessment}

The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of
included studies.\textsuperscript{15} The authors generated a checklist
for representativeness of included cohort, ascertainment of exposure,
comparability and adequacy of follow-up as per the NOS. A maximum of 9
stars were awarded to each study, as determined by 2 independent
reviewers. Studies awarded [?]6 stars were considered moderate-to-high
quality studies.\textsuperscript{15}

\textbf{2.4 Statistical Analysis}

Continuous data (e.g., GLS and FWS) were pooled as a standard mean
difference (SMD) between RVF and none RVF groups. Random effect model
was adopted in all analyses. We assessed between-study heterogeneity
using Q and I\textsuperscript{2}~statistics.
An\emph{I\textsuperscript{2}} statistic \textless{}25\% indicates a low
amount of heterogeneity and \textgreater{}50\% indicates a high
heterogeneity.\textsuperscript{16} We explored sources of heterogeneity
using subgroup analyses by subgrouping the studies based on: (i)
echocardiography modality (transthoracic versus transesophageal
echocardiography) and (ii) Software used for image acquisition (EchoPac
software versus others). We assessed publication bias using Egger
regression test and funnel plots. Analyses were conducted using STATA 16
(State Corp LLC, College Station, Texas). A P-value \textless{}0.05 was
considered statistically significant.

\textbf{3.RESULT}

Preliminary search yielded 1,655 records and after duplicates removal, a
total of 1,585 records were identified for `title and abstract'
screening. Upon `title and abstract' screening, another 1,560 records
were excluded. Twenty-five full-text articles were assessed for
eligibility and of those fifteen studies were included in our analysis.
The flow diagram of the study is depicted in \textbf{Figure 1} .

\textbf{Study Characteristics}

Fifteen studies, with a total number of 967 LVAD recipients, fulfilled
our inclusion criteria.\textsuperscript{8,13,25--29,17--24} Study
characteristics and outcomes are summarized in Table 1 and 2. Eleven
studies used transthoracic echocardiography (TTE) strain, while four
studies utilized transesophageal echocardiography
(TEE)\textsuperscript{17,20,26,29}. The baseline characteristics and
LVAD types of study participants are provided in Table 3. The population
of the cohorts was male predominant, as the proportion of males was
\textgreater{}70\% in all studies. The type of LVAD device varied across
the studies, including: HeartMate II, HeartMate III, and HeartWare
(table 4). Five studies provided both the GLS and
FWS.\textsuperscript{8,22,23,28,30}

\textbf{Global Longitudinal Strain (GLS)}

GLS was reported in 9 studies (7 TTE and 2 TEE
studies).\textsuperscript{8,17,21--23,27--30} The GLS was predictive of
post-operative RVF when analyzed for the whole cohort (TEE and TTE). The
SMD between the No-RVF and the RVF groups was -3.09 (95\% CI: -4.62 to
-1.57; p-value \textless{}0.0001), I\textsuperscript{2}= 92.00\%. When
the TEE-derived GLS is sub-analyzed, there was no statistically
significant difference in GLS between the two groups, with a SMD of
-0.78 (95\% CI: -1.13 to -0.43; p-value =0.54), I\textsuperscript{2}=
0.00\%. Nonetheless, the TTE-derived GLS remained predictive of RVF when
analyzed separately, SMD of -3.97 (95\% CI: -5.40 to -2.54; p-value
\textless{}0.0001), I\textsuperscript{2}= 76.19\%. Forest plot for
pooled SMD in GLS using TTE and TEE modalities is depicted in Figure 2.

\textbf{Free Wall Strain (FWS)}

FWS was reported in 12 studies (9 TTE and 3
TEE).\textsuperscript{8,18,31,19,20,23,24,26,28--30} The FWS for the
whole cohort (TEE and TTE) was found to be significantly worse (less
negative) pre-operatively in patients who suffered RVF compared to
non-RVF group; SMD: -2.75 (95\% CI: -3.72 to -1.79; p-value
\textless{}0.0001), I\textsuperscript{2}=88.08\%. Upon subgroup analysis
based on modality, there was no statistically significant difference in
the TEE-derived FWS between RVF and non-RVF groups; SMD of --1.81 (95\%
CI: -4.00 to 0.38; p-value= 0.07), I\textsuperscript{2}=69.96\%.
However, the TTE-derived FWS was significantly different between both
groups; SMD of -3.05 (95\% CI: -4.11 to -1.99; p-value
\textless{}0.0001), I\textsuperscript{2}= 84.13\%. Forest plot for
pooled SMD in FWS using TTE and TEE modalities is depicted in Figure 3.

\textbf{Heterogeneity}

We further explored between-study heterogeneity using subgroup analysis
based on the software use for image acquisition (EchoPac software versus
others). Subgroup analysis of studies that used EchoPac software was
performed for both the TTE-derived GLS and FWS. Five studies used
EchoPac to analyze the GLS
strain,\textsuperscript{8,22,23,27,31}whereas, four studies used EchoPac
to analyze the strain values for the FWS.\textsuperscript{8,22,23,31} In
the studies using EchoPac, the pooled SMD in GLS between RVF and non-RVF
groups (figure 4) was -3.71 (95\% CI: -5.64 to -1.77; p-value= 0.04),
I\textsuperscript{2}=61.69\%. In EchoPac studies, the SMD in FWS between
RVF and non-RVF groups (figure 5) was -4.48 (95\% CI: -5.97 to -2.98;
p-value \textless{}0.0001), I\textsuperscript{2}= 0.00\%.

\textbf{Quality Assessment}

Quality assessment of included studies using the NOS tool demonstrated
that all studies can be described to be ``moderate-to-high'' in quality.
Of a maximum of 9 starts that can be awarded, all included studies were
awarded either 7 or 8 stars. Detailed results of quality assessment are
exhibited in Table 4.

\textbf{4. DISCUSSION}

Prognosis in patients with advanced HF is dismal, with a 1-year
mortality rate exceeding 25\% and 50\% in patients with class III-IV and
class IV HF, respectively.\textsuperscript{32,33} Nonetheless, data from
the Interagency Registry for Mechanically Assisted Circulatory Support
(INTERMACS) have shown a promising 1-year survival rate of 80\% among
LVAD recipients.\textsuperscript{34} With such favorable outcomes, LVAD
implantation has become the standard of care among patients with
advanced HF -- especially in the face of shortage of donor organs
required for heart transplant. Yet, survival post-LVAD implantation can
be significantly impacted by RVF -- the most common complication
following LVAD implant, occurring in 20--25\% of cases. Further, severe
RVF necessitating additional mechanical support (e.g., RVAD) is reported
to occur in about 15\% of cases.\textsuperscript{6}

Complex hemodynamics and a multitude of variables factor in the
development of RVF following LVAD
implantation.\textsuperscript{35}First, a clinically and hemodynamically
subtle RV dysfunction might have preexisted in many patients prior to
LVAD implantation. This puts them at increased risk of apparent RVF
post-operatively. In addition, RV stroke volume depends in part on the
LV contraction through the interventricular septum, a phenomenon called
``interventricular dependence''.\textsuperscript{36} Improved LV output
after LVAD implantation leads to LV decompression and leftward shift of
the interventricular septum. This would disrupt the normal mechanics of
the RV. Furthermore, fluids and blood products transfusion
peri-operatively might lead to RV distention and exacerbation of
RVF.\textsuperscript{24,25} An intraoperative injury is also a potential
contributor that may worsen RV function.\textsuperscript{37}

In this meta-analysis of observational studies of 967 patients, we
investigated the role of RV strain analysis in predicting RVF in LVAD
recipients. The main findings of the study were: (1) TTE-derived FWS and
RV-GLS were associated with RVF following LVAD implantation, (2)
TEE-derived FWS and RV-GLS were not significantly different between LVAD
recipients who developed RVF and those who did not. However, the second
finding should be interpreted cautiously in light of the limited number
of included studies assessing TEE utility.

The TTE-derived FWS was predictive of RVF postoperatively. Speckle
tracking carries the advantage of angle-independent assessment of
myocardial movement and is sensitive to subendocardial damage, which
produces the strain.\textsuperscript{17} However, it can affected by
poor imaging,\textsuperscript{19} previous cardiac surgery due to
tethering of the RV to the sternum,\textsuperscript{18} and load
dependency.\textsuperscript{17,38} Similarly, TTE-derived GLS showed
discriminatory power to predict post-operative RVF. Muraru \emph{et al}
. showed that inclusion of interventricular septum in strain analysis
yields significantly different strain values from the value from
analyzing RV free-wall alone. Moreover, in their study RV-GLS, as
compared to RV-FWS, correlated better with pulmonary artery systolic
pressure.\textsuperscript{39}

The European Association of Cardiovascular Imaging (EACVI)/the American
Society of Echocardiography (ASE) task force recommends reporting the RV
longitudinal strain as the RV free-wall deformation using the focused RV
apical four-chamber view. They leave it ``optional'' to report the
four-chamber global RV longitudinal strain, which would include the
interventricular septum, as it contributes to a lesser extent to the RV
function.\textsuperscript{40} However, due to altered unloading
conditions and septal mechanics in LVAD recipients, the role of the
interventricular septum is more prominent and crucial to maintain RV
function following implantation.\textsuperscript{2} Therefore, it would
be reasonable to include the interventricular septum in measuring the RV
longitudinal strain. This meta-analysis supports this conclusion as GLS
was predictive for RVF.

Studies have shown variable correlation between TTE- and TEE-derived
strains.\textsuperscript{41--43} Marucci \emph{et al.} described
``moderate'' correlation for global strain, and ``poor'' correlation for
regional stain for the left ventricle in anesthetized
patients.\textsuperscript{41} On the other hand, Kurt \emph{et
al.}demonstrated ``good'' correlation in healthy subjects not undergoing
surgery.\textsuperscript{43} Generally, speckle tracking quality is
dependent on temporal and spatial resolution.\textsuperscript{39} The
higher frame rate provided by TEE results in a different temporal
resolution than that of TTE. And upon adjustment of image sector to
obtain a similar frame rate, the spatial resolution gets affected which
in turn affects the accuracy of delineation of the
endocardium.\textsuperscript{31} Furthermore, mechanical ventilation
increases the RV afterload due to increased intra-thoracic
pressure,\textsuperscript{44} hence decreasing the strain values. It is
hard to draw accurate conclusion about TEE-derived strain given the
small number in our analysis.

Five studies reported cut-offs for predicting post-operative RVF; -9.6,
-10.5, -12.7, -14.4, and -15.5,
respectively.\textsuperscript{19,23,24,27,30} This variability might be
attributed to the different methodologies used to evaluate the strain,
and the definitions of RVF used in individual studies (table 2). The
INTERMACS registry defined mild RVF as elevated CVP \textgreater{}16
mmHg and continued inotropes or pulmonary vasodilators at day 7,
moderate if they are continued at day 14, severe if beyond day 14, and
severe acute right heart failure if death occurs or RVAD is
needed.\textsuperscript{36} The studies included in this meta-analysis
had different RVF definitions, and this may have affected the RVF
reporting rate and contributed to between-study heterogeneity. Three
studied have reported a milder spectrum of
RVF.\textsuperscript{19,21,30} However, other 3 studies reported a
higher spectrum of RVF.\textsuperscript{23,24,28}

In our study, between-study heterogeneity was high for both the pooled
SMD estimate of GLS and FWS. In addition to the variations in RVF
definitions, heterogeneity can be explained by the methodologies of
obtaining the strain values. Sub-group analysis of TEE and TTE groups
did reduce heterogeneity, however it remained moderate-to-high in the
TTE group. Upon analyzing the studies that used ECHOPAC software
separately, heterogeneity was completely eliminated
(I\textsuperscript{2}= 0.00\%\emph{)} in the FWS group. However, the
results were less robust in the GLS group.

This meta-analysis has certain limitations. First, it includes studies
with retrospective design, that could have excluded potential
participants due to poor image quality. This could have introduced a
selection bias. Second, lack of a standardized RVF definition may have
impacted the reported incidence and severity outcomes. Third, use of
modalities (TTE and TEE) with different platforms for image acquisition,
and being interpreted by different personnel could have introduced
measurement and observer bias, respectively.

\textbf{5. CONCLUSION}

TTE-derived RV-FWS and RV-GLS are useful parameters to predict
post-operative RVF in LVAD recipients. However, TEE-derived values seem
to be less predictive. More studies are needed to specify a strain
cut-off value that can reliably predict the adverse outcome of RVF after
LVAD implantation.

\textbf{REFERENCES}

1. Kiamanesh O, Kaan A, Toma M. Medical Management of Left Ventricular
Assist Device Patients: A Practical Guide for the Nonexpert
Clinician.\emph{Can J Cardiol} . 2020;36(2):205-215.
doi:10.1016/j.cjca.2019.09.020

2. Koprivanac M, Kelava M, Siri\selectlanguage{polish}ć \selectlanguage{english}F, Cruz VB, Moazami N, Mihaljevi\selectlanguage{polish}ć \selectlanguage{english}T.
Predictors of right ventricular failure after left ventricular assist
device implantation. \emph{Croat Med J} . 2014;55(6):587-595.
doi:10.3325/cmj.2014.55.587

3. Fitzpatrick JR, Frederick JR, Hsu VM, et al. Risk Score Derived from
Pre-operative Data Analysis Predicts the Need for Biventricular
Mechanical Circulatory Support. \emph{J Hear Lung Transplant} .
2008;27(12):1286-1292. doi:10.1016/j.healun.2008.09.006

4. Matthews JC, Koelling TM, Pagani FD, Aaronson KD. The Right
Ventricular Failure Risk Score. A Pre-Operative Tool for Assessing the
Risk of Right Ventricular Failure in Left Ventricular Assist Device
Candidates. \emph{J Am Coll Cardiol} . 2008;51(22):2163-2172.
doi:10.1016/j.jacc.2008.03.009

5. Hayek S, Sims DB, Markham DW, Butler J, Kalogeropoulos AP. Assessment
of right ventricular function in left ventricular assist device
candidates. \emph{Circ Cardiovasc Imaging} . 2014;7(2):379-389.
doi:10.1161/CIRCIMAGING.113.001127

6. Wang Y, Simon MA, Bonde P, et al. Decision tree for adjuvant right
ventricular support in patients receiving a left ventricular assist
device. \emph{J Hear Lung Transplant} . 2012.
doi:10.1016/j.healun.2011.11.003

7. Atluri P, Goldstone AB, Fairman AS, et al. Predicting right
ventricular failure in the modern, continuous flow left ventricular
assist device era. In: \emph{Annals of Thoracic Surgery} . ; 2013.
doi:10.1016/j.athoracsur.2013.03.099

8. Cameli M, Sparla S, Focardi M, et al. Evaluation of Right Ventricular
Function in the Management of Patients Referred for Left Ventricular
Assist Device Therapy. \emph{Transplant Proc} . 2015;47(7):2166-2168.
doi:10.1016/j.transproceed.2015.02.032

9. Di Minno MND, Forte F, Tufano A, et al. Speckle tracking
echocardiography in patients with systemic lupus erythematosus: A
meta-analysis. \emph{Eur J Intern Med} . 2020;73(December):16-22.
doi:10.1016/j.ejim.2019.12.033

10. Vizzardi E, Bonadei I, Sciatti E, et al. Quantitative analysis of
right ventricular (RV) function with echocardiography in chronic heart
failure with no or mild RV dysfunction: comparison with cardiac magnetic
resonance imaging. \emph{J ultrasound Med Off J Am Inst Ultrasound Med}
. 2015;34(2):247-255. doi:10.7863/ultra.34.2.247

11. Focardi M, Cameli M, Carbone SF rancesc., et al. Traditional and
innovative echocardiographic parameters for the analysis of right
ventricular performance in comparison with cardiac magnetic
resonance.\emph{Eur Heart J Cardiovasc Imaging} . 2015;16(1):47-52.
doi:10.1093/ehjci/jeu156

12. Longobardo L, Suma V, Jain R, et al. Role of Two-Dimensional
Speckle-Tracking Echocardiography Strain in the Assessment of Right
Ventricular Systolic Function and Comparison with Conventional
Parameters. \emph{J Am Soc Echocardiogr} . 2017;30(10):937-946.e6.
doi:10.1016/j.echo.2017.06.016

13. Bellavia D, Iacovoni A, Scardulla C, et al. Prediction of right
ventricular failure after ventricular assist device implant: systematic
review and meta-analysis of observational studies. \emph{Eur J Heart
Fail} . 2017;19(7):926-946. doi:10.1002/ejhf.733

14. Moher D, Liberati A, Tetzlaff J, Altman DG, Group TP. Preferred
Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA
Statement. \emph{PLoS Med} . 2009;6(7):e1000097.
doi:10.1371/journal.pmed.1000097

15. Lo CKL, Mertz D, Loeb M. Newcastle-Ottawa Scale: Comparing
reviewers' to authors' assessments. \emph{BMC Med Res Methodol} .
2014;14(1):45. doi:10.1186/1471-2288-14-45

16. Ioannidis JPA, Patsopoulos NA, Evangelou E. Uncertainty in
heterogeneity estimates in meta-analyses. \emph{Br Med J} . 2007.
doi:10.1136/bmj.39343.408449.80

17. Alfirevic A, Makarova N, Kelava M, Sale S, Soltesz E, Duncan AE.
Predicting Right Ventricular Failure After LVAD Implantation: Role of
Tricuspid Valve Annulus Displacement. \emph{J Cardiothorac Vasc Anesth}
. 2020;34(5):1204-1210. doi:10.1053/j.jvca.2019.08.045

18. Aissaoui N, Salem JE, Paluszkiewicz L, et al. Assessment of right
ventricular dysfunction predictors before the implantation of a left
ventricular assist device in end-stage heart failure patients using
echocardiographic measures (ARVADE): Combination of left and right
ventricular echocardiographic v. \emph{Arch Cardiovasc Dis} .
2015;108(5):300-309. doi:10.1016/j.acvd.2015.01.011

19. Aymami M, Amsallem M, Adams J, et al. The Incremental Value of Right
Ventricular Size and Strain in the Risk Assessment of Right Heart
Failure Post - Left Ventricular Assist Device Implantation. \emph{J Card
Fail} . 2018;24(12):823-832. doi:10.1016/j.cardfail.2018.10.012

20. Beck DR, Foley L, Rowe JR, et al. Right Ventricular Longitudinal
Strain In Left Ventricular Assist Device Surgery--A Retrospective Cohort
Study. \emph{J Cardiothorac Vasc Anesth} . 2017;31(6):2096-2102.
doi:10.1053/j.jvca.2017.07.018

21. Boegershausen N, Zayat R, Aljalloud A, et al. Risk factors for the
development of right ventricular failure after left ventricular assist
device implantation-a single-centre retrospective with focus on
deformation imaging. \emph{Eur J Cardiothorac Surg} .
2017;52(6):1069-1076. doi:10.1093/ejcts/ezx123

22. Cameli M, Lisi M, Righini FM, et al. Speckle tracking
echocardiography as a new technique to evaluate right ventricular
function in patients with left ventricular assist device therapy.\emph{J
Hear Lung Transplant} . 2013;32(4):424-430.
doi:10.1016/j.healun.2012.12.010

23. Charisopoulou D, Banner NR, Demetrescu C, Simon AR, Haley SR. Right
atrial and ventricular echocardiographic strain analysis predicts
requirement for right ventricular support after left ventricular assist
device implantation. \emph{Eur Heart J Cardiovasc Imaging} .
2019;20(2):199-208. doi:10.1093/ehjci/jey065

24. Grant ADM, Smedira NG, Starling RC, Marwick TH. Independent and
incremental role of quantitative right ventricular evaluation for the
prediction of right ventricular failure after left ventricular assist
device implantation. \emph{J Am Coll Cardiol} . 2012;60(6):521-528.
doi:10.1016/j.jacc.2012.02.073

25. Gumus F, Sar\selectlanguage{polish}ı\selectlanguage{english}caoglu C, Inan MB, Akar AR. Right Ventricular Strain to
Assess Early Right Heart Failure in the Left Ventricular Assist Device
Candidate. \emph{Curr Heart Fail Rep} . 2019;16(6):212-219.
doi:10.1007/s11897-019-00445-y

26. Magunia H, Dietrich C, Langer HF, et al. 3D echocardiography derived
right ventricular function is associated with right ventricular failure
and mid-term survival after left ventricular assist device
implantation.\emph{Int J Cardiol} . 2018;272(2017):348-355.
doi:10.1016/j.ijcard.2018.06.026

27. Kato TS, Jiang J, Schulze PC, et al. Serial echocardiography using
tissue Doppler and speckle tracking imaging to monitor right ventricular
failure before and after left ventricular assist device
surgery.\emph{JACC Heart Fail} . 2013;1(3):216-222.
doi:10.1016/j.jchf.2013.02.005

28. Wang L, Zucker MJ, Cohen M, et al. Pre-operative speckle-tracking
imaging to predict the need for right ventricular support in patients
undergoing left ventricular assist device implantation. \emph{J
Cardiovasc Dis Res} . 2015;6(1):1-11. doi:10.5530/jcdr.2015.1.1

29. Silverton NA, Patel R, Zimmerman J, et al. Intraoperative
Transesophageal Echocardiography and Right Ventricular Failure After
Left Ventricular Assist Device Implantation. \emph{J Cardiothorac Vasc
Anesth} . 2018;32(5):2096-2103. doi:10.1053/j.jvca.2018.02.023

30. Gumus F, Durdu MS, Cakici M, et al. Right ventricular free wall
longitudinal strain and stroke work index for predicting right heart
failure after left ventricular assist device therapy. \emph{Interact
Cardiovasc Thorac Surg} . 2019;28(5):674-682. doi:10.1093/icvts/ivy328

31. Bellavia D, Iacovoni A, Agnese V, et al. Usefulness of regional
right ventricular and right atrial strain for prediction of early and
late right ventricular failure following a left ventricular assist
device implant: A machine learning approach. \emph{Int J Artif Organs} .
2019. doi:10.1177/0391398819884941

32. Crespo-Leiro MG, Anker SD, Maggioni AP, et al. European Society of
Cardiology Heart Failure Long-Term Registry (ESC-HF-LT): 1-year
follow-up outcomes and differences across regions. \emph{Eur J Heart
Fail} . 2016. doi:10.1002/ejhf.566

33. Gustafsson F, Rogers JG. Left ventricular assist device therapy in
advanced heart failure: patient selection and outcomes. \emph{Eur J
Heart Fail} . 2017. doi:10.1002/ejhf.779

34. Kirklin JK, Naftel DC, Pagani FD, et al. Sixth INTERMACS annual
report: A 10,000-patient database. \emph{J Hear Lung Transplant} .
2014;33(6):555-564. doi:10.1016/j.healun.2014.04.010

35. Haddad F, Couture P, Tousignant C, Denault AY. The right ventricle
in cardiac surgery, a perioperative perspective: II. Pathophysiology,
clinical importance, and management. \emph{Anesth Analg} .
2009;108(2):422-433. doi:10.1213/ane.0b013e31818d8b92

36. Muslem R, Ong CS, Tomashitis B, et al. Pulmonary arterial elastance
and INTERMACS-defined right heart failure following left ventricular
assist device. \emph{Circ Hear Fail} . 2019;12(8):1-11.
doi:10.1161/CIRCHEARTFAILURE.119.005923

37. Chen JM, Levin HR, Rose EA, et al. Experience with right ventricular
assist devices for perioperative right-sided circulatory
failure.\emph{Ann Thorac Surg} . 1996;61(1):303-305.
doi:10.1016/0003-4975(95)01010-6

38. Eskandr AM, Metwally AA, Abu Elkassem MS, et al. Dobutamine and
Nitroglycerin Versus Milrinone for Perioperative Management of Pulmonary
Hypertension in Mitral Valve Surgery. A Randomized Controlled
Study.\emph{J Cardiothorac Vasc Anesth} . 2018;32(6):2540-2546.
doi:10.1053/j.jvca.2018.04.032

39. Muraru D, Onciul S, Peluso D, et al. Sex- and method-specific
reference values for right ventricular strain by 2-dimensional
speckle-tracking echocardiography. \emph{Circ Cardiovasc Imaging} .
2016;9(2):1-10. doi:10.1161/CIRCIMAGING.115.003866

40. Badano LP, Kolias TJ, Muraru D, 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.\emph{Eur Heart J Cardiovasc Imaging} . 2018;19(6):591-600.
doi:10.1093/ehjci/jey042

41. Marcucci CE, Samad Z, Rivera J, et al. A comparative evaluation of
transesophageal and transthoracic echocardiography for measurement of
left ventricular systolic strain using speckle tracking. \emph{J
Cardiothorac Vasc Anesth} . 2012;26(1):17-25.
doi:10.1053/j.jvca.2011.06.002

42. Freedberg DE, Toussaint NC, Chen SP, et al. Proton Pump Inhibitors
Alter Specific Taxa in the Human Gastrointestinal Microbiome: A
Crossover Trial. \emph{Gastroenterology} . 2015;149(4):883-5.e9.
doi:https://dx.doi.org/10.1053/j.gastro.2015.06.043

43. Kurt M, Tanboga IH, Isik T, et al. Comparison of transthoracic and
transesophageal 2-dimensional speckle tracking echocardiography. \emph{J
Cardiothorac Vasc Anesth} . 2012;26(1):26-31.
doi:10.1053/j.jvca.2011.05.014

44. Cherpanath TGV, Lagrand WK, Binnekade JM, Schneider AJ, Schultz MJ,
Groeneveld JAB. Impact of Positive End-Expiratory Pressure on
Thermodilution-Derived Right Ventricular Parameters in Mechanically
Ventilated Critically Ill Patients. \emph{J Cardiothorac Vasc Anesth} .
2016. doi:10.1053/j.jvca.2015.09.010

Figure 1: PRISMA flow-chart showing the search strategy and studies
selection process.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image1/image1}

\end{center}
\end{figure}

\textbf{Figure 2: Forest plot depicting pooled SMD in GLS between RVF
and non-RVF groups, stratified by imaging modality (TEE and TTE).}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image2/image2}

\end{center}
\end{figure}

\textbf{Figure 3: Forest plot showing pooled SMD in FWS between RVF and
non-RVF groups, stratified by imaging modality (TEE and TTE).}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image3/image3}

\end{center}
\end{figure}

\textbf{Figure 2: Forest plot showing pooled SMD in TTE-derived GLS
between RVF and non-RVF groups in studies using ECHOPAC software.}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image4/image4}

\end{center}
\end{figure}

\textbf{Figure 2: Forest plot showing pooled SMD in TTE-derived FWS
between RVF and non-RVF groups in studies using ECHOPAC software.,
stratified by imaging modality (TEE and TTE).}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image5/image5}

\end{center}
\end{figure}

\textbf{Table 1. Characteristics and Outcomes of Studies Included in the
Analysis.}

\textbf{Study}

\textbf{Design}

\textbf{Modality}

\textbf{Software}

\textbf{Patients Number (N)}

\textbf{RVF,}

n (\%)

\textbf{Inclusion criteria}

\textbf{Endpoints}

Alfirevic, 2019

Retrospective

TEE

Ultrasound Philips platform

86

15 (17\%)

LVAD patients with TAD, strain, and TAPSE measures available.

RVF occurring after LVAD implantation (before hospital discharge).

Assouie, 2015

Prospective

TTE

QLAB CMQ, Philips

42

24 (57\%)

Patients undergoing LVAD therapy

RVF following LVAD implantation.

Aymami, 2017

Retrospective

TTE

Philips IE 33 US systems

158

60 (38\%)

Patients who underwent implantation of CF- LVAD

Early (\textless{} 30 days) postoperative RV failure

Beck, 2017

Retrospective

TEE

Syngo US Workplace

57

21(36.8\%)

Patients with a non-pulsatile durable LVAD

A composite of 6-month death, \textgreater{}14 days inotropes, need for
mechanical RV support, or device thrombosis requiring explant.

Bellavia, 2019

Retrospective

TTE

GE EchoPac

64

8 (11\%)

Patients referred to HVAD implantation at ISMETT and Papa Giovanni
XXIII.

RVF following LVAD implantation.

Boegershausen, 2017

Retrospective

TTE

GE EchoPac

54

13 (24\%)

Patient with CF-LVAD implantation at the study site

RVF following CF-LVAD implantation.

Cameli, 2013

Prospective

TTE

GE EchoPac

10

3 (30\%)

Patients referred for LVAD therapy.

RVF following LVAD implantation.

Cameli, 2015

Prospective

TTE

GE EchoPac

19

4 (16\%)

Patients referred for LVAD therapy.

RVF following LVAD implantation.

Charisopoulou, 2018

Retrospective

TTE

Vivid 7 and EchoPac

70

14 (20\%)

Patients who underwent CF- LVAD implantation

RV failure requiring RVAD implantation within 30 days.

Grant, 2012

Prospective

TTE

Syngo Velocity Vector Imaging, (Siemens)

117

47 (40\%)

Patients undergoing LVAD implantation

RVF following LVAD implantation.

Gumus, 2018

Retrospective cohort study

TTE and TEE

Not Reported

57

20 (35\%)

Patients with LVAD as a bridge to transplant.

RVF following LVAD implantation.

Kato, 2013

Prospective

TTE

GE EchoPac

68

24 (35.3\%)

Patients undergoing LVAD

RVF following LVAD implantation.

Magunia, 2018

Retrospective study

TEE

TOMETEC Image-Arena

26

5 (19.2\%)

Patients undergoing CF-LVAD implantation

RVF following CF-LVAD implantation.

Silverton, 2018

Retrospective

TEE

EchoInsight

100

19 (19\%)

systolic heart failure patients with elective LVAD implantation.

RVF following LVAD implantation.

Wang, 2015

Prospective

TTE

Syngo Velocity Vector Imaging, (Siemens)

39

11 (39\%)

Patients with second-generation CF- LVAD

Death or implantation of an RVAD due to acute RVF within 6 months of
LVAD implant.

\textbf{*Abbreviations --} TTE: transthoracic echocardiography; TEE:
transesophageal echocardiography; LVAD: left ventricular assist device;
CF-LVAD: continuous flow LVAD; RVF: right-ventricular failure; HVAD:
HeartWare ventricular assist device.

\textbf{Table 2. Definitions of Right Ventricular Failure (RVF) Across
Included Studies.}\selectlanguage{english}
\begin{longtable}[]{@{}ll@{}}
\toprule
\begin{minipage}[b]{0.47\columnwidth}\raggedright\strut
\textbf{Study}\strut
\end{minipage} & \begin{minipage}[b]{0.47\columnwidth}\raggedright\strut
\textbf{RVF definition}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Alfirevic, 2019\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
The need for RVAD or prolonged (\textgreater{} 14 days) intravenous
inotropic or inhaled vasodilator medications after LVAD implantation.
Patients requiring RVAD owing to inability to separate from bypass
during the LVAD procedure.\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Assouie, 2015\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
The need for placement of a temporary RVAD or the use of inotropic
agents for 14 days.\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Aymami, 2017\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Early (\textless{}30 days) RVF predefined according to the INTERMACS
definition as sustained elevation of central venous pressure
\textgreater{} 16 mmHg and the need for prolonged inotropes beyond 7
days, or the unplanned need for RVAD implantation.\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Beck, 2017\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Adverse events: A composite of one or more of the following: death
within 6 months, \textgreater{}14 days on inotropes, need for mechanical
RV support, or device thrombosis requiring explant.\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Bellavia, 2019\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
The need for intravenous inotropes for \textgreater{}2 weeks; persistent
RV stroke work index (RVSW) \textless{} 4.0 g/m2; or nitric oxide
inhalation for \textgreater{} 48 h at any rotation speed or saline
infusion; or presence of acute RVF when emergent/ urgent need for
mechanical RV support was considered mandatory.\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Boegershausen, 2017\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
The need for an RVAD or the requirement of inhaled nitric oxide or
inotropic therapy for \textgreater{}1 week any time after LVAD
implantation in the presence of symptoms and signs of persistent RV
dysfunction.\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Cameli, 2013\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
The post-operative need of intravenous inotrope support for
\textgreater{}14 days or of inhaled nitric oxide for \textgreater{}48
hours, or the need for right-sided circulatory support or RVAD, or for
hospital discharge with an intravenous inotrope.\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Cameli, 2015\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
The post-operative need of intravenous inotrope support for
\textgreater{}14 days or of inhaled nitric oxide for \textgreater{}48
hours, or the need for right-sided circulatory support.\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Charisopoulou, 2018\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
RVAD implantation within 30 days\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Grant, 2012\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
The need for placement of an RVAD, or the use of inotropic agents for
\textgreater{} 14 days.\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Gumus, 2018\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
The need for RVAD, prolonged (\textgreater{} 14 days) intravenous
inotropic or inhaled vasodilator medications after LVAD implantation,
MAP \textless{} 55 mmHg, or CVP or right atrial pressure \textgreater{}
16 mmHg.\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Kato, 2013\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
The need for salvage RVAD, or persistent need for inotrope and/ or
pulmonary vasodilator therapy 14 days after surgery.\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Magunia, 2018\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Prolonged inotropic support for \textgreater{} 14 days after LVAD
implantation or consecutive implantation of RVAD .\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Silverton, 2018\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
14 consecutive days of inotrope therapy or subsequent RVAD
implantation.\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
Wang, 2015\strut
\end{minipage} & \begin{minipage}[t]{0.48\columnwidth}\raggedright\strut
The need for continuous post-operative inotropic agents for
\textgreater{}14 days, pulmonary vasodilator use (inhaled nitric oxide)
\textgreater{} 48 hours, or right-sided mechanical support.\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\textbf{*Abbreviations --} LVAD: left ventricular assist device; RVAD:
right ventricular assist device; RVF: right-ventricular failure; CVP:
central venous pressure.

\textbf{Table 3. Demographics (Age and Sex) and LVAD Type Across
Included Studies.}\selectlanguage{english}
\begin{longtable}[]{@{}lllllll@{}}
\toprule
\begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{Study}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{Age}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{Age}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{Sex (Male)}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{Sex (Male)}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{LVAD type}\strut
\end{minipage} & \begin{minipage}[b]{0.12\columnwidth}\raggedright\strut
\textbf{LVAD type}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{No RVF}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{RVF}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{No RVF}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{RVF}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{No RVF}\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
\textbf{RVF}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Alfirevic, 2019\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
58 \selectlanguage{ngerman}±12\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
56 \selectlanguage{ngerman}±14\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
57 (80\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
14 (93\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
HeartMate II: 36 (50.7) HeartMate III: 13 (18.3) HeartWare: 22
(31.0\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
HeartMate II: 7 (46.7\%) HeartMate III: 4 (26.7\%) HeartWare: 4
(26.7\%)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Assouie, 2015\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
60 (48-69)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
52 (43-61)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
18 (100\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
21 (88\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Aymami, 2017\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
56.6 \selectlanguage{ngerman}±12.8\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
46.8 \selectlanguage{ngerman}±15.5\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
70 (71\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
45 (90\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Beck, 2017\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
51.0 \selectlanguage{ngerman}±15.5\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
57.3 \selectlanguage{ngerman}± 10.5\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
32 (89\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
14 (67\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
HeartMate II: 31 (86) HeartWare: 5 (14)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
HeartMate II :2 (10\%) HeartWare :19 (90\%)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Bellavia, 2019\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
59 \selectlanguage{ngerman}± 11\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
54 \selectlanguage{ngerman}± 13\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
51 (91\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
7 (88\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Boegershausen, 2017\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
60.6 \selectlanguage{ngerman}±7.6\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
63.2\selectlanguage{ngerman}±7.2\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
36 (88\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
10 (77\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Cameli, 2013\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
66.4 (5.1)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
65.8\selectlanguage{ngerman}±4.8\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
6 (86\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
3 (100\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Cameli, 2015\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Charisopoulou, 2018\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
48 \selectlanguage{ngerman}± 12\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
45 \selectlanguage{ngerman}± 11\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
50 (89\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
9 (64\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
HeartMate III 4(10.8)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
HeartMate III 4 (20)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Grant, 2012\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
58 (47--65)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
92 (79\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Gumus, 2018\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
40.0 \selectlanguage{ngerman}± 15.0\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
39.8 \selectlanguage{ngerman}± 22.6\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
34 (92\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
13 (65\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
HeartWare 21 (56.7)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
HeartWare: 7 (35\%)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Kato, 2013\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
62.5 \selectlanguage{ngerman}±12.4\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
62.8 \selectlanguage{ngerman}± 10.6\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
39 (89\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
22 (92\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Magunia, 2018\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
64 \selectlanguage{ngerman}± 13\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
58 \selectlanguage{ngerman}± 30\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
19 (91\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
5 (100\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Heartmate II: 14 (66.7\%) Heartmate III: 4 (19\%) HeartWare 3:
(14.3\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Heartmate II: 11 (20\%) Heartmate III: 3 (60\%) HeartWare: 1
(20\%)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Silverton, 2018\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
60.6\selectlanguage{ngerman}± 13.4\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
64\selectlanguage{ngerman}± 11.2\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
71 (88\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
18 (95\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
HeartMate II: 39 (48.1) HeartMate III: 0 (0.0\%) HeartWare: 37 (45.7\%)
Jarvik 2000: 4 (4.9\%)\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
HeartMate II: 8 (42.1\%) HeartMate III: 1 (5.3\%) HeartWare 8: (42.1\%)
Jarvik 2000 2: (10.5\%)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
Wang, 2015\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
56\selectlanguage{ngerman}±15\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
57\selectlanguage{ngerman}±16\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
22 (78\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
9 (82\%)\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage} & \begin{minipage}[t]{0.12\columnwidth}\raggedright\strut
---\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\textbf{Table 4. Quality Assessment of Included Studies Using the
Newcastle-Ottawa Scale (NOS).}\selectlanguage{english}
\begin{longtable}[]{@{}llllll@{}}
\toprule
\begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
\textbf{Selection} \textbf{(max of 4 stars)}\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
\textbf{Comparability} \textbf{(max of 2 stars)}\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
\textbf{Outcome} \textbf{(max of 3 stars)}\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
\textbf{Total Score (max of 9)}\strut
\end{minipage} & \begin{minipage}[b]{0.16\columnwidth}\raggedright\strut
\textbf{Overall Quality}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Alfirevic, 2019\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{****}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{*}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{***}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Moderate-to-high\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Assouie, 2015\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{****}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{*}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{***}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Moderate-to-high\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Aymami, 2017\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{****}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{*}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{***}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Moderate-to-high\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Beck, 2017\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{***}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{*}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{***}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
7\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Moderate-to-high\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Bellavia, 2019\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{****}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{*}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{***}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Moderate-to-high\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Boegershausen, 2017\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{****}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{*}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{***}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Moderate-to-high\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Cameli, 2013\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{****}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{*}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{***}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Moderate-to-high\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Cameli, 2015\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{***}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{*}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{***}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
7\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Moderate-to-high\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Charisopoulou, 2018\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{***}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{*}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{***}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
7\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Moderate-to-high\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Grant, 2012\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{****}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{*}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{***}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Moderate-to-high\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Gumus, 2018\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{***}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{*}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{***}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
7\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Moderate-to-high\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Kato, 2013\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{****}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{*}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{***}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Moderate-to-high\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Magunia, 2018\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{****}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{*}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{***}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Moderate-to-high\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Silverton, 2018\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{****}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{*}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{***}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Moderate-to-high\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Wang, 2015\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{****}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{*}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
\textbf{***}\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
8\strut
\end{minipage} & \begin{minipage}[t]{0.14\columnwidth}\raggedright\strut
Moderate-to-high\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

\selectlanguage{english}
\FloatBarrier
\end{document}

