Association between Cardiac MRI-derived Global Longitudinal Strain and Clinical Outcomes in Chronic Aortic Regurgitation.
TL;DR
Cardiac MRI-derived LV GLS was associated with clinical end points in patients with chronic AR and was independently associated with outcomes after adjustment for age, sex, symptoms, and log EuroSCORE II.
Abstract
Purpose To examine the prognostic value of cardiac MRI-assessed left ventricular (LV) global longitudinal strain (GLS) in patients with moderate to severe chronic aortic regurgitation (AR). Materials and Methods This was a multicenter retrospective study of patients with isolated chronic moderate to severe AR who underwent cardiac MRI between January 2012 and February 2020, within 90 days of the baseline echocardiographic diagnosis. LV volumes, LV ejection fraction (LVEF), and LV GLS were measured with cardiac cine MRI with feature tracking. The end point was all-cause death or heart failure-related hospitalization. Statistical analyses included multivariable Cox proportional hazards regression to assess the association of LV GLS with outcomes, adjusting for age, sex, symptoms, and log EuroSCORE II. Results The study included 175 patients (median age, 58 years [IQR, 44-69 years]; 118 male). Median LVEF and LV GLS were 57% (IQR, 49%-64%) and -14.1% (IQR, -16.1% to -11.4%), respectively. During median follow-up of 3.4 years (IQR, 1.7-5.8 years), aortic valve replacement (AVR) was performed in 64 patients (37%). Composite end point occurred in 23% of patients (n = 41: 11 deaths and 30 heart failure-related hospitalizations). Multivariable analysis revealed that LV GLS ≥ -14% was independently associated with primary outcome in patients receiving medical management (adjusted hazard ratio, 8.70 [95% CI: 2.5, 30]; P < .001), after adjustment for age, sex, symptoms, and log EuroSCORE II. After AVR, patients with LV GLS < -14% had better outcomes (P = .02). In the overall cohort, LV GLS ≥ -14% was independently associated with outcomes (adjusted hazard ratio, 2.47 [95% CI: 1.38-4.43]; P = .002) after adjusting for age, sex, time-dependent AVR, and log EuroSCORE II. Conclusion Cardiac MRI-derived LV GLS was associated with clinical end points in patients with chronic AR. Keywords: Aortic Regurgitation, Aortic Valve, Cardiac MRI, Echocardiography, Left Ventricular Global Longitudinal Strain, MR-Functional Imaging, Cardiac Supplemental material is available for this article. © RSNA, 2026.