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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
Volume 36 (2026): Issue 2 (June 2026)
By: ,  ,   and    
Open Access
|Jun 2026
Figures & tables

Figures & Tables

Table 1

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

1 Data is presented as mean ± SD or frequency (%).

1* Significant p value < 0.05. BMI: Body mass index, HFpEF: heart failure with preserved ejection fraction

Table 2

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

1 Data is presented as mean ± SD or frequency (%). P value < 0.05 is statistically significant. AF: Atrial fibrillation; Ao: Aortic diameter; EDV: End-diastolic volume; E/e’: Ratio of early diastolic velocity to early diastolic filling; EF: ejection fraction; FS: Fractional shortening; HFpEF: Heart failure with preserved ejection fraction; IVSd: Interventricular septal thickness in diastole; LA: Left atrium; LVIDd: Left ventricular internal diameter in diastole; LVIDs: Left ventricular internal diameter in systole; LVPWd: Left ventricular posterior wall thickness in diastole; MAPSE: Mitral annular plane systolic excursion; PASP: Pulmonary artery systolic pressure; SV: Stroke volume; TAPSE: Tricuspid annular plane systolic excursion; e’: Early diastolic velocity.

Table 3

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*

1 Data is presented as mean ± SD. P value ˂0.05 is statistically significant. HFpEF: Heart failure with preserved ejection fraction; RV: Right ventricle; GLS: global longitudinal strain; RV: Right ventricle; NT-proBNP: N-terminal pro-brain natriuretic peptide.

Table 4

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*

1 r: Pearson correlation. P value < 0.05 is statistically significant. RV: right ventricle, RA: right atrium, NT-proBNP: N-terminal pro-brain natriuretic peptide, GLS: global longitudinal strain.

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.

Table 5

ROC curve of NT-proBNP in the prediction of HFpEF.

AUCCutoffSensitivitySpecificityPPVNPV95% CI
LowerUpper
NT-Pro-BNP0.9538396%94%97%92%0.930.97

1 AUC: Area under the cdurve; PPV: Positive predictive value; NPV: Negative predictive value; CI: Confidence interval, NT-proBNP: N-terminal pro-brain natriuretic peptide.

DOI: https://doi.org/10.2478/rjc-2026-0002 | Journal eISSN: 2734-6382 | Journal ISSN: 1220-658X
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Language: English
Page range: 90 - 97
Published on: Jun 30, 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,
Pediatrics and juvenile medicine,
Paediatric cardiology,
Surgery,
Cardiac surgery

© 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.

Volume 36 (2026): Issue 2 (June 2026)
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