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• Clinical Article •
Biventricular strain in dilated cardiomyopathy: A comparative study between heart failure with mildly reduced ejection fraction and heart failure with preserved ejection fraction
ZHANG Linxin  QI Haicheng  CHEN Ying  DUAN Lian  YAN Jun  XING Yan 

Cite this article as: ZHANG L X, QI H C, CHEN Y, et al. Biventricular strain in dilated cardiomyopathy: A comparative study between heart failure with mildly reduced ejection fraction and heart failure with preserved ejection fraction[J]. Chin J Magn Reson Imaging, 2025, 16(9): 66-73. DOI:10.12015/issn.1674-8034.2025.09.011.


[Abstract] Objective To quantitatively assess correlations and differences in biventricular function between patients with heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF) in the context of dilated cardiomyopathy (DCM) using cardiovascular magnetic resonance feature-tracking (CMR-FT), and to evaluate the predictive value of biventricular myocardial strain parameters for HFmrEF.Materials and Methods Clinical and imaging data of patients diagnosed with heart failure and previously confirmed DCM were retrospectively collected from the First Affiliated Hospital of Xinjiang Medical University between January 2021 and June 2024. Conventional cardiac magnetic resonance (CMR) parameters and myocardial strain parameters were obtained using the CVI42 software. Based on heart failure characteristics, patients were divided into HFmrEF and HFpEF groups. Baseline clinical data, basic CMR parameters, and global/segmental myocardial strain parameters were compared between the two groups. Elastic-net regularized regression and multivariate logistic regression were used to identify independent factors associated with HFmrEF in DCM patients and to construct receiver operating characteristic (ROC) curves.Results A total of 67 patients were enrolled, including 28 in the HFpEF group and 39 in the HFmrEF group. Significant differences were observed between the two groups in N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hs-TnT), and myoglobin levels (all P < 0.05). Compared with the HFpEF group, the HFmrEF group showed significantly reduced biventricular stroke volume index, left ventricular cardiac output, and cardiac index (all P < 0.05); significantly increased biventricular end-diastolic/end-systolic volume indices and myocardial mass index (all P < 0.05); and impaired global and segmental myocardial strain (all P < 0.05 except for LV apical longitudinal strain). Multivariate logistic regression analysis identified right ventricular stroke volume index (OR = 0.863, P = 0.008), left ventricular mid longitudinal strain (OR = 1.406, P = 0.004), and right ventricular mid longitudinal strain (OR = 1.110, P = 0.025) as independent predictors of HFmrEF. The area under the ROC curve of the three-variable combined model was the largest, at 0.896 (95% CI: 0.823 to 0.968).Conclusions CMR-FT can accurately characterize myocardial strain in DCM patients with HFmrEF and HFpEF. Right ventricular stroke volume index, left ventricular mid longitudinal strain, and right ventricular mid longitudinal strain serve as independent predictors of HFmrEF in DCM patients, providing important assessment value for this patient subgroup.
[Keywords] cardiovascular magnetic resonance；dilated cardiomyopathy；heart failure；feature-tracking；myocardial strain；ejection fraction

ZHANG Linxin1   QI Haicheng1   CHEN Ying1   DUAN Lian2   YAN Jun2   XING Yan1*  

1 Imaging Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China

2 Imaging Center, Xinjiang Cardiovascular and Cerebrovascular Hospital, Urumqi 830011, China

Corresponding author: XING Y, E-mail: xingyanzwb@sina.com

Conflicts of interest   None.

Received  2025-06-11
Accepted  2025-09-10
DOI: 10.12015/issn.1674-8034.2025.09.011
Cite this article as: ZHANG L X, QI H C, CHEN Y, et al. Biventricular strain in dilated cardiomyopathy: A comparative study between heart failure with mildly reduced ejection fraction and heart failure with preserved ejection fraction[J]. Chin J Magn Reson Imaging, 2025, 16(9): 66-73. DOI:10.12015/issn.1674-8034.2025.09.011.

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