Atrial Strain Outperforms Ventricular Strain for Detecting Hypertensive HFpEF Using CMR Feature Tracking

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) accounts for ≈50% of heart failure, and hypertension often coexists. Although strain imaging detects subclinical dysfunction, the relative diagnostic value of left atrial (LA) versus left ventricular (LV) strain for identifying hypertensive HFpEF remains uncertain. We compared LA and LV strain using cardiac MR feature tracking to determine optimal markers for HFpEF detection. METHODS: A single-center, retrospective study included 191 participants: 71 with HFpEF and hypertension (HFpEF-HTN), 60 with essential hypertension, and 60 controls who underwent cardiac MR. Cardiac MR feature tracking quantified LV global strains and strain rates, and LA reservoir (εs), conduit (εe), and booster pump (εa) strain with corresponding strain rates. One-way ANOVA compared groups, logistic regression identified HFpEF-HTN predictors, and receiver operating characteristic analysis with area under the curve assessed diagnostic accuracy. RESULTS: