Background <p>Hemodynamically significant tricuspid regurgitation (TR) often leads to right ventricular (RV) dysfunction, which is associated with poor outcome. Estimation of RV function is difficult using conventional echocardiographic parameters. We aimed to compare the association of right ventricular free-wall longitudinal strain (RVfwLS) with outcome to that of conventional RV function parameters in TR.</p> Methods <p>A systematic review and meta-analysis were conducted per PRISMA guidelines. PubMed and Scopus databases were searched for studies reporting the association of RVfwLS with adverse outcomes such as all-cause mortality and cardiopulmonary events. Studies that reported hazard ratios (HRs) of RVfwLS, tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (RVFAC), systolic pulmonary arterial pressure (sPAP), and left ventricular ejection fraction (LVEF) were also collected. HRs were pooled using a random-effects model, and ratio of HR per 1 standard deviation change between RVfwLS and other parameters were calculated for direct comparison.</p> Results <p>Of 4,288 publications, 11 studies involving 12 patient cohorts were included for analysis. Mean age was 71&#xa0;years, with follow-up periods ranging from 18 to 60&#xa0;months. RVfwLS was associated with outcome (HR: 1.09, 95% confidence interval: 1.07 – 1.12). RVfwLS provided greater prognostic value than sPAP, RVFAC, and LVEF.</p> Conclusions <p>RVfwLS is a more accurate predictor of adverse outcomes than conventional parameters in patients with TR, suggesting its potential role in managing patients.</p>