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y, PTT was independent and complementary to both pulmonary artery pressure and reduced RV ejection fraction42% to predict overall mortality and secondary combined endpoints. Despite limitations in temporal resolution, PTT derived from first-pass perfusion imaging provides higher and independent prognostic information in heart failure with reduced ejection fraction than clinical and other cMR parameters, including LV and RV ejection fraction or feature tracking global longitudinal strain. Registration URL https//www.clinicaltrials.gov