Diagnosing heart failure with preserved ejection fraction (HFpEF) remains challenging, as right heart catheterisation (RHC) is the reference standard but underused in practice. Findings presented at the European Society of Cardiology Congress 2025 show that a strain-based imaging method may provide a reliable non-invasive alternative.

Data from 209 patients with RHC and CMR defined formulae for estimating PCWP from left atrial strain (Es) and volume index (ESVi). Validation in 74 patients from the HFpEF-Stress trial confirmed strong accuracy.
Strain-derived PCWPrest (11.8 mmHg) matched invasive measurements (11 mmHg, p=0.285) and correlated well (r=0.53, p<0.001). Diagnostic performance was high, with AUC values of 0.80 at rest and 0.85 under stress, significantly better than older volume/mass-based methods (AUC 0.67). Importantly, higher calculated

PCWP predicted cardiovascular hospitalisations at four years.
The results highlight left atrial strain and volume index as reliable tools for PCWP estimation, supporting broader adoption in HFpEF management.