Aims: Left ventricular global longitudinal strain (GLS) by cardiac magnetic resonance feature tracking (CMR-FT) analysis has shown an incremental prognostic value compared to classical parameters in non-ischemic dilated cardiomyopathy (NICM). However, less is known about the role of right ventricular (RV) GLS. Our objective was to evaluate the prognostic impact of RV-GLS by CMR-FT analysis in a population of NICM patients.

Methods: In this multicenter study, we examined NICM patients evaluated with a comprehensive CMR-FT study. Major cardiac events (MACEs) were considered as the study primary outcome measure and were defined as a composite of (a) cardiovascular death, (b) cardiac transplant or destination therapy ventricular assist device, (c) hospitalization for life-threatening ventricular arrhythmias or implantable cardiac defibrillator appropriate intervention. Heart failure (HF) related events, including hospitalizations and life-threatening arrhythmia-related events were considered as secondary end-points. Receiver operating time-dependent analysis were used to calculate the possible additional effect of RV-GLS to standard evaluation.

Results: We consecutively enrolled 273 patients. During a median follow-up of 39 months, 41 patients (15%) experienced MACEs. RV-GLS and LV late gadolinium emerged as the strongest prognostic CMR-FT variables: their association provided an estimated 3-year MACEs rate of 29%. The addition of RV-GLS significantly improved the prognostic accuracy in predicting MACEs with respect to the standard evaluation including LGE (areas under the curve from 0.71 [0.66–0.82] to 0.76 [0.66–0.86], p = 0.03). On competing risk analysis, RV-GLS showed a significant ability to reclassify overall both HF-related and life-threatening arrhythmia-related events, regardless of LV and RV ejection fraction.

Conclusions: In NICM patients, RV-GLS showed a significant prognostic role in reclassifying the risk of MACEs, incremental with respect to standard evaluation with standard prognostic parameters.

目标：与非缺血性扩张型心肌病 (NICM) 的经典参数相比，通过心脏磁共振特征跟踪 (CMR-FT) 分析得出的左心室整体纵向应变 (GLS) 显示出增加的预后价值。然而，对右心室 (RV) GLS 的作用知之甚少。我们的目标是通过 CMR-FT 分析评估 RV-GLS 对 NICM 患者群体的预后影响。

方法：在这项多中心研究中，我们检查了通过综合 CMR-FT 研究评估的 NICM 患者。主要心脏事件 (MACE) 被视为研究的主要结果指标，并被定义为 (a) 心血管死亡，(b) 心脏移植或目的地治疗心室辅助装置，(c) 因危及生命的室性心律失常住院或植入式心脏除颤器适当干预。心力衰竭 (HF) 相关事件，包括住院和危及生命的心律失常相关事件，被视为次要终点。接收器操作时间相关分析用于计算 RV-GLS 对标准评估可能产生的额外影响。

结果：我们连续招募了 273 名患者。在 39 个月的中位随访期间，41 名患者 (15%) 经历了 MACE。RV-GLS 和 LV 晚期钆成为最强的预后 CMR-FT 变量：它们的关联提供了 29% 的估计 3 年 MACE 率。RV-GLS 的加入显着提高了预测 MACE 的预后准确性，包括 LGE（曲线下面积从 0.71 [0.66-0.82] 到 0.76 [0.66-0.86]，p= 0.03）。在竞争风险分析中，RV-GLS 显示出对 HF 相关和危及生命的心律失常相关事件进行重新分类的显着能力，无论 LV 和 RV 射血分数如何。

结论： 在 NICM 患者中，RV-GLS 在重新分类 MACE 风险方面显示出重要的预后作用，相对于使用标准预后参数的标准评估而言是递增的。