What does this research mean for the field?

Lateral subendocardium-involved LGE and septal midwall LGE predict sudden cardiac death in patients with dilated cardiomyopathy, with a new risk model showing a C-statistic improvement of 0.23 over conventional indicators. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The aim is to evaluate the prognostic value of late gadolinium enhancement (LGE) phenotypes for sudden cardiac death in dilated cardiomyopathy.

January 10, 2026

Subendocardium-involved late gadolinium enhancement in nonischemic dilated cardiomyopathy improves risk stratification of sudden cardiac death

Key Result

Lateral subendocardium-involved LGE and septal midwall LGE predicted SCD in DCM, with the risk model showing C-statistic improvement of 0.23 over conventional indicators.

Key Points

The aim is to evaluate the prognostic value of late gadolinium enhancement (LGE) phenotypes for sudden cardiac death in dilated cardiomyopathy.
Retrospective enrollment of DCM patients undergoing cardiac MRI.
Analysis of subendocardial and mid-wall LGE phenotypes in patients.
Risk stratification model creation based on observed LGE types.
51 (5.7%) patients experienced SCD events during a median follow-up of 77 months.
Lateral subendocardium-involved LGE and septal midwall LGE predicted SCD events with HRs of 3.07 and 3.59 respectively.
A three-tier risk model was developed, showing significant improved risk stratification over conventional methods.

Structured PICO

Does the presence of lateral subendocardium-involved and septal midwall late gadolinium enhancement (LGE) on cardiac MRI improve risk stratification for sudden cardiac death in patients with nonischemic dilated cardiomyopathy?

Population

902 patients with nonischemic dilated cardiomyopathy (DCM) who underwent cardiac MRI, mean age 46±14 years, 78.7% men.

Intervention

Presence of specific late gadolinium enhancement (LGE) phenotypes on cardiac MRI (lateral subendocardium-involved LGE and septal midwall LGE)

Comparator

Absence of these LGE phenotypes (lowest risk group: neither septal midwall nor lateral subendocardium-involved LGE)

Outcome

Composite of sudden cardiac death (SCD) and surrogate SCD eventscomposite

Integrating lateral subendocardium-involved and septal midwall LGE phenotypes on cardiac MRI significantly improves sudden cardiac death risk stratification in nonischemic dilated cardiomyopathy compared to LVEF alone.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Aims The prognostic value of late gadolinium enhancement (LGE) phenotypes-particularly subendocardial involvement-for sudden cardiac death (SCD) remains unclear in dilated cardiomyopathy (DCM). Whether LGE phenotype integrating pattern and location can improve SCD risk stratification is an unmet need. Methods and results DCM patients who underwent cardiac MRI were retrospectively enrolled. The endpoint was a composite of SCD and surrogate SCD events. Among 902 patients (mean age 46±14 years, 78.7% men), subendocardium-involved and mid-wall LGE were observed in 129 (14.3%) and 263 (29.1%) patients, predominantly involving the lateral (65.1%) and septal wall (97.7%), respectively. During a median follow-up of 77 months (IQR 40-92 months), 51 (5.7%) patients experienced SCD events. Multivariable analysis identified septal midwall LGE (HR 3.59; 95% CI 1.73-7.47; P = .001) and lateral subendocardium-involved LGE (HR 3.07; 95% CI 1.39-6.75; P = .005) as independent predictors. A three-tier risk stratification model was developed, classifying patients into: lowest risk (neither septal midwall nor lateral subendocardium-involved LGE; reference), intermediate risk (either phenotype alone; HR 4.8, 95% CI 2.2-10.46, P .001), and highest risk (both phenotypes; HR 10.71, 95% CI 3.53-32.46, P .001). The model showed the best improvement in model discrimination and reclassification over left ventricular ejection fraction (C-statistic improvement: 0.23; net reclassification improvement = 0.67; integrative discrimination index = 0.27; all P .05). Conclusions SCD was predicted by both lateral subendocardium-involved LGE and septal midwall LGE in DCM. The novel SCD risk model integrating these phenotypes demonstrated superior prognostic performance compared to conventional prognosticators.

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