Key result
In patients with chronic moderate-to-severe aortic regurgitation, decreased FT-LVGLS was independently associated with MACE (adjusted HR 1.210 per 1% decrease, P<0.007).
Why the study?
To evaluate the prognostic and incremental value of CMR feature tracking-derived LVGLS beyond 2025 ESC/EACTS Class I/IIb surgical indication parameters in chronic moderate to severe aortic regurgitation.
Does CMR FT-LVGLS improve risk stratification for MACE in patients with chronic moderate to severe aortic regurgitation?
Cohort (n=385)
Does CMR FT-LVGLS improve risk stratification for MACE in patients with chronic moderate to severe aortic regurgitation?
CMR-derived FT-LVGLS provides incremental prognostic value beyond standard guideline-based surgical indication parameters in asymptomatic or minimally symptomatic patients with chronic moderate-to-severe aortic regurgitation.
May refine MACE risk stratification in moderate-to-severe AR beyond guidelines; leaves open prospective validation before practice change.
AIM: To evaluate the prognostic value of cardiac magnetic resonance (CMR) feature tracking-derived left ventricular global longitudinal strain (FT-LVGLS) for adverse outcomes in patients with chronic moderate to severe aortic regurgitation (AR), and to further assess its incremental prognostic value in predicting adverse outcomes beyond the 2025 ESC/EACTS Class I/IIb surgical indication parameters. METHODS AND RESULTS: This retrospective cohort study initially screened 707 patients with at least moderate chronic AR who underwent CMR between 2010 and 2024, of whom 385 with no or minimal symptoms (NYHA class I-II; mean age 54.1 ± 13.5 years; 329 male) constituted the primary study cohort. The primary endpoint was major adverse cardiac events (MACE), defined as all-cause mortality, heart transplantation, unplanned hospitalization for heart failure, or implantable cardioverter defibrillator discharge. During a median follow-up of 52.9 months, 45 patients experienced MACE. Multivariable Cox regression identified FT-LVGLS as independently associated with MACE (adjusted HR: 1.210 per 1% decrease in absolute FT-LVGLS, P < .007). Incorporating FT-LVGLS into prognostic models containing each ESC/EACTS Class I/IIb surgical indication parameter (dichotomized by guideline-recommended thresholds) consistently improved model discrimination for MACE, with C-index increasing from 0.730-0.768 to 0.783-0.791 and likelihood ratio χ2 values from 36.04-41.12 to 50.10-52.07. Kaplan-Meier survival curves demonstrated that an absolute FT-LVGLS cutoff of 12% further refined risk stratification. CONCLUSION: In NYHA class I-II patients with chronic moderate-to-severe AR, FT-LVGLS was independently associated with MACE and provided incremental prognostic value beyond ESC/EACTS guideline-based surgical indication parameters, supporting its potential role in improving risk identification.
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Li et al. (2026) conducted a cohort in Chronic moderate to severe aortic regurgitation (n=385). CMR feature tracking-derived left ventricular global longitudinal strain (FT-LVGLS) was evaluated on Major adverse cardiac events (MACE), defined as all-cause mortality, heart transplantation, unplanned hospitalization for heart failure, or ICD discharge (HR 1.210, p=< .007). In patients with chronic moderate-to-severe aortic regurgitation, decreased FT-LVGLS was independently associated with MACE (adjusted HR 1.210 per 1% decrease, P<0.007).
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