Prognostic significance of right ventricular global longitudinal strain assessed by CMR feature tracking in patients with heart failure with reduced ejection fraction
M Ciarlantini, D Fedele, L Bergamaschi, M Armillotta, F Angeli, S Frittella, R Tarantini, I Torre, A G Pavon, P Van Der Harst, C Pizzi, J Schwitter, A I Guaricci, M Guglielmo, G PontoneAbstract
Background
left ventricular global longitudinal strain (LV GLS) is an established prognostic markers in patients with heart failure with reduced ejection fraction (HFrEF), providing incremental value beyond conventional imaging parameters. In contrast, the prognostic role of right ventricular global longitudinal strain (RV GLS), particularly when assessed by cardiac magnetic resonance feature tracking (CMR-FT), remains less well defined.
Purpose
This study aimed to evaluate the prognostic value of CMR-FT–derived RV GLS in patients with ischemic and non-ischemic cardiomyopathy (ICM and NICM) and HFrEF.
Methods
A total of 1,810 patients (mean age 60 ± 14 years, 76% male) were included, with a median follow-up of 1,006 days (578–1,577 days). Major adverse cardiovascular event (MACE) occurred in 455 patients (25%). Mean RV GLS was −19.6 ± 6%. Patients experiencing MACE had significantly impaired RV GLS compared with event-free patients (−18.4 ± 6% vs −19.9 ± 6%, p < 0.001). The optimal cut-off for MACE prediction was RV GLS = −23.2%, yielding an AUC of 0.60. After adjustment for clinical variables (age, diabetes, atrial fibrillation, NYHA class III–IV) and standard CMR parameters (RV dimensions, left ventricular ejection fraction, and presence of late gadolinium enhancement), RV GLS ≥ −23.2% remained independently associated with MACE (adjusted HR 1.27, 95% CI 1.00–1.61; p = 0.049).
Conclusion
RV GLS derived from CMR feature tracking provides independent prognostic information beyond established clinical and imaging markers in patients with both ischemic and non-ischemic cardiomyopathy. An RV GLS threshold of ≥ −23.2% identifies patients at higher risk of all-cause mortality or heart failure events and may support enhanced risk stratification in this population.Kaplan-meier survival curvesFor image description, please refer to the figure legend and surrounding text.