Cardiac MRI Strain Metrics Reveal Predictive Insights for Heart Failure Risk

In one of the largest cardiac MRI studies of its kind, researchers have demonstrated that strain measurements from the right ventricle (RV) offer significant prognostic value in identifying individuals at risk of developing heart failure (HF). The findings, derived from cardiac MRI data on more than 45,000 participants in the UK Biobank, highlight right ventricular global longitudinal strain (RV GLS) as an independent and clinically meaningful predictor of future HF events—even when accounting for conventional risk factors and imaging markers.

While left ventricular ejection fraction (LVEF) remains a standard measure in heart failure assessments, it can overlook subtle dysfunction, particularly in early or right-sided cardiac involvement. This study shifts attention to myocardial strain—specifically RV GLS, global circumferential strain (GCS), and global radial strain (GRS)—as potentially more sensitive markers of early cardiac impairment.

The research, published in Radiology: Cardiothoracic Imaging leveraged advanced cardiac MRI feature tracking (FT) to evaluate RV myocardial deformation along multiple axes. All three strain types were significantly associated with incident HF during a median three-year follow-up. Notably, RV GLS stood out as the only metric to remain independently predictive of HF after adjusting for established RV measures, such as right ventricular ejection fraction (RVEF) and end-diastolic volume (RVEDV), with a hazard ratio of 1.16.

“Our findings show that RV strain—especially global longitudinal strain—adds valuable prognostic insight beyond what standard RV metrics offer,” the authors noted. “This could help clinicians identify high-risk individuals earlier in the disease process, even before conventional imaging detects a problem.”

The data included over 45,000 participants with an average age of 65 and balanced gender representation. RV strain values were derived using automated analysis software, which enabled standardized, large-scale image processing. On average, the RV GLS for the cohort was −25%, a value slightly higher than those typically reported from echocardiography.

Strain metrics were predictive even after accounting for factors such as age, sex, smoking status, BMI, hypertension, and coronary artery disease. However, when left ventricular strain was included in the model, the predictive power of RV strain diminished—suggesting that left-sided function remains a dominant indicator in the general population. Still, the authors emphasize that RV strain may offer added utility in certain subgroups, particularly in conditions where right heart dysfunction plays a central role, such as pulmonary hypertension, chronic lung disease, or congenital heart disease.

The study also acknowledged challenges in translating RV strain into clinical practice, including the absence of standardized reference ranges and limitations in imaging protocols that were not optimized for the RV. Moreover, although the predictive value of RV strain was statistically significant, the overall incremental benefit to clinical models was modest—highlighting the need for further validation in more diverse populations and targeted disease settings.

Despite these limitations, the research provides a critical step toward integrating RV strain into routine cardiac risk assessment. As cardiac MRI continues to evolve, strain imaging may soon become a powerful adjunct in identifying patients at risk of heart failure—well before symptoms emerge.