Right Atrial Phasic Function Improves CMR-Based Prognostication in Patients with Heart Failure with Mildly Reduced Ejection Fraction: A Multicenter Study
Wenxian Wang, Runze Zhu, Yan Gao, Jian Wang, Wen Liu, Jie Liu, Liang WU, Wanting Wang, Kairui Bo, Ximing WangAbstract
Aims
In multiple cardiovascular diseases, right atrial (RA) function can serve as an independent predictor for the clinical status and prognosis. However, the prognostic value of RA strain in patients with heart failure with mildly reduced ejection fraction (HFmrEF) remains considerably unknown. This study aims to explore the relationships between RA strain derived from cardiac magnetic resonance imaging-feature tracking (CMR-FT) and adverse outcomes in patients with HFmrEF.
Methods and Results
This retrospective study enrolled patients with HFmrEF who were referred for echocardiography and CMR at two tertiary medical centers from April 2016 to September 2024. The primary endpoint was a composite of all-cause mortality, HF-related hospitalization and cardiac transplantation. The findings were validated in a cohort of patients with HFmrEF enrolled from two additional tertiary care centers (January 2019 to January 2025). The development cohort included 1317 patients, and the validation cohort comprised 385 patients. During a median follow-up period of 2.8 years and 2.1 years, respectively, 243 and 72 patients in the development cohort and validation cohort reached the primary endpoint, respectively. Cox regression analysis showed that RA conduit strain was an independent predictor of the primary outcome (HR: 0.86 [0.82, 0.90]; P < .001). The full model integrating clinical variables, traditional imaging, and RA strain achieved the best predictive performance (C-index: 0.80 in development, 0.81 in validation cohorts).
Conclusion
RA conduit strain derived from CMR is an independent predictor of adverse outcomes in patients with HFmrEF, providing incremental prognostic value beyond traditional clinical and imaging-derived risk markers.