Right ventricular Strain on MRI Independently Predicts Death Risk in HFpE, reveals research

HFpEF represents almost half of all heart failure, and whereas left ventricular function has received most of the attention in terms of research and treatment, increasing evidence indicates that RV function is also extremely important in disease progression and mortality. But up to this point, its direct prognostic utility in HFpEF has not been well established.

This retrospective analysis compared two independent cohorts of patients with HFpEF who received cardiac MRI from January 2010 through June 2021. The development cohort was 1019 patients (mean age: 56.9 years ± 12.3; 710 men), and the validation cohort was 273 patients (mean age: 55.3 years ± 14.0; 191 men). The major outcome measured was all-cause mortality.

Cardiac MRI feature-tracking was utilized to quantify RV global longitudinal and circumferential strain. Cox regression models assessed the predictive value of these parameters on death, adjusting for clinical variables and standard imaging parameters. Median follow-up times were 7.8 years for the development cohort and 3.9 years for the validation cohort.

Main Findings

• 103 patients out of 1019 (10.1%) died during follow-up in the development cohort.

• In the validation cohort, 9 (3.3%) of 273 patients died.RV global longitudinal strain was associated with an adjusted hazard ratio (HR) of 1.07 per 1% increase in strain (95% CI: 1.02–1.12; P = 0.005).

• RV circumferential strain was associated with an adjusted HR of 1.13 per 1% increase (95% CI: 1.05–1.21; P< 0.001).

• The complete prognostic model with RV strain had excellent discrimination with a C-index of 0.794 in the development cohort and 0.782 in the validation cohort.

• In a subset with more advanced tissue characterization (T1 mapping), RV strain remained predictive of death after controlling for native T1 values and extracellular volume fraction (P<0.05 for all models).

Right ventricular global longitudinal and circumferential strain from cardiac MRI were independent, potent predictors of all-cause mortality in HFpEF patients. These findings suggest that RV strain is a more accurate prognosticator than conventional risk factors or routine imaging markers. Incorporating Right ventricular strain analysis into standard cardiac MRI evaluations could greatly enhance risk stratification and patient care in HFpEF.

Reference:

Zhu, L., Zhang, H., Jiang, M., Xu, J., Zhou, D., Wu, W., Yang, W., Wang, Y., Yin, G., Sirajuddin, A., Arai, A. E., Zhang, Q., Zhao, S., & Lu, M. (2025). Right ventricular strain improves cardiac MRI-based prognostication in heart failure with preserved ejection fraction. Radiology, 315(3), e243080.https://doi.org/10.1148/radiol.243080