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Right atrial and ventricular strain in heart failure with preserved ejection fraction: Correlation with N-terminal pro-brain natriuretic peptide Cover

Right atrial and ventricular strain in heart failure with preserved ejection fraction: Correlation with N-terminal pro-brain natriuretic peptide

Romanian Journal of Cardiology
AHEAD OF PRINT
By: Mohamed Fahmy El Noamany,  Ashraf Abdelraof Dawood,  Sara Mohamed Elzeiny and  Suzy Salah Lasheen  
Open Access
|Mar 2026

Figures & Tables

Figure 1

(A) Right ventricular strain analysis: GS: 11.3%, FWS: 15.1%, TAPSE: 1.2 cm (all below normal), HR: 95 bpm, FR: 53 fps. Right panel shows longitudinal strain curve and color-coded strain map (red = higher strain, blue = lower strain). (B) Right atrial strain analysis: HR: 81 bpm, FR: 51 fps, peak strain: 22%, S_CD: 23%, S_CT: 0%, RAVmax: 54 ml. Right panel displays strain rate curve with peak at 22%. Abbreviations: GS = global strain; FWS = free-wall strain; TAPSE = tricuspid annular plane systolic excursion; FR = frame rate; HR = heart rate; S_CD = strain at end-diastole; S_CT = strain at end-systole; RAVmax = maximum RA volume in 4-chamber view.
(A) Right ventricular strain analysis: GS: 11.3%, FWS: 15.1%, TAPSE: 1.2 cm (all below normal), HR: 95 bpm, FR: 53 fps. Right panel shows longitudinal strain curve and color-coded strain map (red = higher strain, blue = lower strain). (B) Right atrial strain analysis: HR: 81 bpm, FR: 51 fps, peak strain: 22%, S_CD: 23%, S_CT: 0%, RAVmax: 54 ml. Right panel displays strain rate curve with peak at 22%. Abbreviations: GS = global strain; FWS = free-wall strain; TAPSE = tricuspid annular plane systolic excursion; FR = frame rate; HR = heart rate; S_CD = strain at end-diastole; S_CT = strain at end-systole; RAVmax = maximum RA volume in 4-chamber view.

Right ventricular and right atrial diameters and strain parameters, together with N-terminal pro-brain natriuretic peptide (NT-proBNP) level, among the studied groups_

HFpEF Group (N=39)Control Group (N=20)P
RV basal diameter (cm)3.13 ± 0.543.26 ± 0.630.43
RV mid diameter (cm)2.56 ± 0.532.78 ± 0.580.15
RV longitudinal diameter (cm)5.59 ± 0.765.34 ± 0.690.21
RA septal-lateral diameter (cm)3.7 ± 0.53.4 ± 0.20.001*
RA apico-basal diameter (cm)4.6 ± 0.64.2 ± 0.40.003*
Right ventricle longitudinal strain
RV free wall %19.6 ± 7.3328 ± 4.31< 0.001*
RV septal wall %15.2 ± 3.4932.5 ± 5.93< 0.001*
RV GLS %16.79 ± 3.9625.35 ± 1.89< 0.001*
Right atrial strain %20.94 ± 8.7839.95 ± 2.03< 0.001*
NT-proBNP pg./ml610 ±15.6103 ±7< 0.001*

Heart rhythm and conventional echocardiographic parameters in the studied groups_

HFpEF Group (N = 39)Control Group (N = 20)P
ECGAF15 (38.5%)0 (0%)0.001*
Sinus Rhythm24 (61.5%)20 (100%)
IVSd (cm)1.3 ± 0.240.82 ± 0.12< 0.001*
LVIDd (cm)4.7± 0.35.2 ± 0.3< 0.001*
LVIDs (cm)3.01 ± 0.33.1 ± 0.20.367
LVPWd (cm)1.2 ± 0.20.8 ± 0.1< 0.001*
EDV (ml)102.2 ± 31.4114.6 ± 25.60.133
EF (%)66.17 ± 5.8966.4 ± 4.480.884
SV (ml)80 ± 8.775.15±15.30.12
Conventional echocardiographyFS (%)36.48 ± 4.736.5 ± 2.90.991
LA diameter (mm)39.41± 8.830.66 ± 8.2< 0.001*
Ao (mm)30.4 ± 7.127.05 ± 6.090.07
e’ lateral (cm/s)6.5 ± 0.614 ± 3< 0.001*
E (cm/s)82 ± 1595 ± 13< 0.001
E/e’12.91 ± 2.026.7 ± 1.79< 0.001*
MAPSE (cm)1.56 ± 0.152.25 ± 0.21< 0.001*
TAPSE (cm)1.72 ± 0.232.23 ± 0.21< 0.001*
PASP (mmHg)43.57± 11.0322± 5< 0.001

Correlations between NT-proBNP and RV longitudinal and RA strain in the studied group_

NT-proBNP pg./ml
rP
RA strain %-0.739< 0.001*
RV longitudinal strain %
RV free-wall %-0.505< 0.001*
RV septal-wall %-0.849< 0.001*
RV GLS %-0.737< 0.001*

Distribution of demographic and cardiovascular risk factors among the studied groups_

HFpEF Group (N = 39)Control Group (N = 20)P
Age (years)52.7 ± 8.648.5 ± 10.60.106
SexMale10 (25.6%)4 (20%)0.63
Female29 (74.4%)16 (80%)
BMI (kg/m2)23.27 ± 1.522.13 ± 1.40.006*
Total Cholesterol (mg/dL)182.56 ± 16.4167.5 ± 11.50.001*
ComorbiditiesSmoking6 (15.4%)0 (0%)0.064
Hypertension5 (12.8%)0 (0%)0.094
Diabetes Mellitus4 (10.2%)0 (0%)0.138

ROC curve of NT-proBNP in the prediction of HFpEF_

AUCCutoffSensitivitySpecificityPPVNPV95% CI
LowerUpper
NT-Pro-BNP0.9538396%94%97%92%0.930.97
DOI: https://doi.org/10.2478/rjc-2026-0002 | Journal eISSN: 2734-6382 | Journal ISSN: 1220-658X
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Language: English
Published on: Mar 2, 2026
Published by: Romanian Society of Cardiology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
Heart Failure with Preserved Ejection Fraction,
Echocardiography,
Speckle-Tracking,
Brain Natriuretic Peptide,
Right ventricle,
Right atrium
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Cardiology,
Surgery,
Cardiac surgery,
Pediatrics and juvenile medicine,
Paediatric cardiology

© 2026 Mohamed Fahmy El Noamany, Ashraf Abdelraof Dawood, Sara Mohamed Elzeiny, Suzy Salah Lasheen, published by Romanian Society of Cardiology
This work is licensed under the Creative Commons Attribution 4.0 License.

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