HEART failure with preserved ejection fraction (HFpEF) represents a growing burden in cardiovascular care, characterised by complex pathophysiology and limited treatment options. Prognostic markers in HFpEF are still being refined, particularly with regard to right ventricular (RV) function. While RV function is a known independent predictor in various heart conditions, the specific value of RV strain measures in HFpEF has remained uncertain. A recent study has provided evidence that RV strain, assessed by cardiac MRI, is a significant predictor of long-term mortality in patients with HFpEF.
Researchers retrospectively analysed cardiac MRI data from 1019 patients with HFpEF, scanned between 2010 and 2018, with a validation cohort of 273 patients imaged from 2019 to 2021. Cardiac MRI feature tracking was used to quantify RV global longitudinal strain (GLS) and circumferential strain (GCS). The primary endpoint was all-cause mortality, and associations were tested using multivariable Cox regression analysis. Validation of findings and adjustment for myocardial tissue characteristics using T1 mapping was also conducted in a subgroup.
During median follow-up periods of 7.8 and 3.9 years for the development and validation cohorts, 103 and nine deaths were recorded. After adjusting for clinical and imaging factors, RV GLS and GCS remained independently associated with mortality. For each 1% increase (i.e., worsening) in RV GLS, the hazard of death increased by 7% (hazard ratio [HR]: 1.07; 95% CI: 1.02–1.12; p=0.005), and for RV GCS, the hazard increased by 13% (HR: 1.13; 95% CI: 1.05–1.21; p<0.001). Prognostic models incorporating RV strain demonstrated high discriminative performance, with C indices of 0.794 in the development cohort and 0.782 in the validation group.
This study confirms that RV strain measurements derived from cardiac MRI offer meaningful prognostic insight in HFpEF beyond conventional imaging markers. The findings support incorporating RV GLS and GCS into risk stratification models in clinical practice, potentially enabling earlier identification of high-risk patients. Limitations include the retrospective design, single-centre data, and the small number of events in the validation cohort, which may affect generalisability. Nonetheless, RV strain analysis represents a valuable tool for enhancing prognostic assessment in HFpEF and may inform future therapeutic strategies.
Reference
Zhu L et al. Right Ventricular Strain Improves Cardiac MRI–based Prognostication in Heart Failure with Preserved Ejection Fraction. Radiology. 2025;DOI: 10.1148/radiol.243080.
