Key result
Higher CMR right atrial conduit strain links to ~14% lower composite outcome risk in HFmrEF.
Why the study?
Although right atrial function independently predicts prognosis across multiple cardiovascular diseases, the prognostic value of CMR-FT-derived right atrial strain in patients with HFmrEF remained largely unknown.
Does right atrial strain derived from CMR-FT improve prognostic prediction of all-cause mortality, HF hospitalization, and cardiac transplantation in patients with HFmrEF?
Cohort (n=1,702)
Yes
Does right atrial strain derived from CMR-FT improve prognostic prediction of all-cause mortality, HF hospitalization, and cardiac transplantation in patients with HFmrEF?
Right atrial conduit strain assessed via CMR feature tracking independently predicts adverse clinical outcomes and adds incremental prognostic value to traditional clinical and imaging markers in patients with HFmrEF.
May support RA strain for HFmrEF prognostication; leaves open validation in prospective cohorts before clinical use.
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.
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Wang et al. (2026) conducted a cohort in Heart failure with mildly reduced ejection fraction (HFmrEF) (n=1,702). Right atrial (RA) conduit strain derived from CMR-feature tracking vs. Traditional clinical and imaging-derived risk markers was evaluated on Composite of all-cause mortality, HF-related hospitalization, and cardiac transplantation (HR 0.86, 95% CI 0.82-0.90, p=<0.001).
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