Global longitudinal strain (GLS) assessed by cardiac magnetic resonance imaging (MRI) may be predictive of hospitalization for heart failure and cardiovascular (CV) death in patients with heart failure and preserved ejection fraction (HFpEF), according to a study published in Radiology.

This was a secondary analysis of an observational, prospective study ( Identifier: NCT03405987) in which 206 consecutive patients with HFpEF (mean age, 71 years) underwent cardiovascular MRI, including 3-dimensional strain analysis and T1 mapping. Investigators prospectively followed participants with ambulatory visits and telephone calls every 6 months.

The prognostic value of MRI-derived myocardial strain for heart failure hospitalizations and cardiovascular death was assessed in a Cox regression analysis adjusted for age, diabetes, renal function, N-terminal pro–b-type natriuretic peptide serum concentration, and right ventricular size and function.

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The median GLS was -8.5% and had low correlations with native T1 times (r=0.21; P =.02) and extracellular volume (r=0.28; P =.003). The global circumferential strain had low correlations with native T1 times (r=0.20; P =.03) and extracellular volume (r=0.21; P =.02).

During a follow up of 38±29 months, a total of 109 hospitalizations for heart failure and CV death events were reported. Higher event rates were observed in participants with a GLS above the median (P <.001). The GLS was found to be an independent predictor of heart failure hospitalization and cardiovascular death in a multivariable Cox regression analysis (hazard ratio, 1.06 per 1% strain increase; 95% CI, 1.01-1.11; P =.03).

Limitations of this study include the fact that participants were enrolled from a single center, a relatively small sample size, and the lack of right-sided heart catheterization in all participants.

The researchers noted that “global longitudinal strain of the left ventricular myocardium by using cardiac MRI adds to the portfolio of this emerging technique.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Kammerlander AA, Donà C, Nitsche C, et al. Feature tracking of global longitudinal strain by using cardiovascular MRI improves risk stratification in heart failure with preserved ejection fraction [published online June 2, 2020]. Radiology. doi:10.1148/radiol.2020200195