Distinct CMR Phenotype in Alcoholic Cardiomyopathy: Greater Myocardial Fibrosis and Right Ventricular Dysfunction Compared with Idiopathic Dilated Cardiomyopathy

Figures

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  Figure 1. Schematic illustration of the four late gadolinium enhancement (LGE) patterns assessed in this study, shown in short-axis cardiac cross-section. Each panel shows the left ventricular (LV) myocardium (grey), cavity (black), right ventricle (RV, crescent), and LGE distribution (white). Midwall linear LGE (ACM 25% vs. DCM 8%, p = 0.033) was the only pattern which was significantly increased in ACM. RV insertion point LGE (ACM 45% vs. DCM 23%, p = 0.056) is a recognized non-specific finding that occurs in healthy individuals and carries no established prognostic significance. * p < 0.05; (Fisher’s exact test). ACM, alcoholic cardiomyopathy; DCM, dilated cardiomyopathy; LGE, late gadolinium enhancement; LV, left ventricle; RV, right ventricle.

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  Figure 2. Individual right ventricular ejection fraction (RVEF) values by etiology. Box plot with individual patient values shown for ACM (n = 20, maroon) and idiopathic DCM (n = 128, navy). Boxes represent the interquartile range (IQR) with the median line. The dashed line indicates the RVEF < 45% threshold for right ventricular dysfunction according to ESC guidelines. Note the heterogeneous RVEF distribution in ACM (IQR 35.2–55.0%) relative to the idiopathic DCM group. Mann–Whitney U, p = 0.010.

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  Figure 3. Multivariable predictors of right ventricular dysfunction (RVEF < 45%). Forest plot of OR for all covariates in the fully adjusted logistic regression model (outcome: RVEF < 45%; n = 148; events n = 43). ACM etiology and LVEF were independently associated with RV dysfunction. C-statistic = 0.775; Hosmer–Lemeshow test p = 0.884; EPV = 10.8. Filled diamonds: p < 0.05; open circles: p ≥ 0.05. The asterisk means the results achieve statistical significance.

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  Figure 4. CMR characterization of alcoholic vs. idiopathic dilated cardiomyopathy. (A) Prevalence of LGE patterns in ACM (maroon) vs. idiopathic DCM (navy). The “Any LGE” bar is split: solid segments are patients with LGE excluding isolated RV insertion point; shaded segments are patients with RV insertion point LGE (non-specific, occurs in healthy individuals). When the RV insertion point pattern was excluded, non-RV-IP LGE: ACM 45% vs. DCM 22.7% (p = 0.051, NS). Significance markers: * p < 0.05 (Fisher’s exact test). (B) Forest plot of odds ratios (ORs) for LGE presence across sequential logistic regression models. Filled diamonds, p < 0.05. Dashed vertical line = OR 1.0. Continuous predictors standardized (per 1 SD). CI, confidence interval; LVEF, left ventricular ejection fraction; OR, odds ratio; RVEF, right ventricular ejection fraction; EPV, events-per-variable. The asterisk means the results achieve statistical significance (p < 0.05).