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Magnetic Resonance Derived Myocardial Strain Assessment Using Feature Tracking
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Magnetic Resonance Derived Myocardial Strain Assessment Using Feature Tracking

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CMR-Derived Global Longitudinal Strain and Left Ventricular Torsion as Prognostic Markers in Dilated Cardiomyopathy

Alexandru Zlibut1,2, Michael Bietenbeck2, Lucia Agoston-Coldea1,3,4

  • 1Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.

Journal of Cardiovascular Development and Disease
|September 26, 2025
PubMed

Insights

Cardiovascular magnetic resonance (CMR) measures of global longitudinal strain (GLS) and left ventricular (LV) torsion predict major adverse cardiovascular events in dilated cardiomyopathy (DCM) patients. These myocardial mechanics offer improved risk stratification beyond ejection fraction and LGE.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Biomedical Engineering

Background:

  • Non-ischemic dilated cardiomyopathy (DCM) presents heterogeneous progression and high risk of major adverse cardiovascular events (MACEs).
  • Cardiovascular magnetic resonance (CMR) provides comprehensive assessment of myocardial structure, function, and fibrosis.
  • Prognostic value of CMR-derived myocardial mechanics in DCM requires further investigation.

Purpose of the Study:

  • To evaluate the prognostic significance of CMR-derived global longitudinal strain (GLS) and left ventricular (LV) torsion in patients with non-ischemic DCM.
  • To compare the predictive capabilities of GLS and LV torsion against conventional imaging metrics.

Main Methods:

  • Prospective enrollment of 150 DCM patients and 100 healthy controls.
  • Standardized CMR protocols including cine imaging, late gadolinium enhancement (LGE), and feature-tracking analysis for myocardial deformation.
  • Quantification of LV volumes, ejection fraction (LVEF), GLS, and LV torsion; primary endpoint: MACE over a median 33-month follow-up.

Main Results:

  • DCM patients exhibited significantly impaired LV function and mechanics (lower LVEF, reduced GLS, diminished LV torsion) compared to controls.
  • Reduced GLS (≤ -8.6%) and LV torsion were independently associated with increased MACE risk (adjusted HRs: 1.09 and 1.37, respectively).
  • Late gadolinium enhancement (LGE) presence further stratified risk (HR: 2.86).

Conclusions:

  • CMR-derived GLS and LV torsion are potent, independent predictors of adverse outcomes in DCM.
  • Integrating myocardial deformation analysis enhances risk stratification beyond LVEF and LGE.
  • These findings support routine use of GLS and LV torsion assessment in DCM patient management.
Abstract

Keywords:
cardiovascular magnetic resonancedilated cardiomyopathyfeature trackingglobal longitudinal strainlate gadolinium enhancementleft ventricular torsionmyocardial fibrosisrisk stratification

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