Key result
RVEF <40% predicts ~119% higher MACE risk in NDLVC patients with reduced ejection fraction.
Why the study?
Non-dilated left ventricular cardiomyopathy is a novel cardiomyopathy, and this study aimed to explore its clinical and CMR characteristics compared with DCM and assess event rates in NDLVC with reduced LVEF.
What are the clinical and CMR characteristics of NDLVC compared with DCM, and what are the prognostic predictors of adverse events in NDLVC?
Cohort (n=396)
What are the clinical and CMR characteristics of NDLVC compared with DCM, and what are the prognostic predictors of adverse events in NDLVC?
NDLVC patients exhibit better LVEF and lower LGE prevalence than DCM patients, and right ventricular ejection fraction is a powerful predictor of adverse events in NDLVC.
RVEF <40% may refine risk stratification in NDLVC-REF; hypothesis-generating and requires prospective validation before practice change.
OBJECTIVES: Non-dilated left ventricular cardiomyopathy (NDLVC) is a novel cardiomyopathy characterised by normal LV size and non-ischaemic myocardial scarring or fatty tissue replacement. This study aimed to explore the clinical and cardiac magnetic resonance (CMR) characteristics of NDLVC compared with dilated cardiomyopathy (DCM) and event rates of patients with NDLVC and reduced LV ejection fraction (NDLVC-REF). MATERIALS AND METHODS: A retrospective cohort study of 396 patients, including 210 with NDLVC (135 classified as NDLVC-REF) and 186 with DCM, who underwent CMR imaging between 2015 and 2017, was conducted. Follow-up lasted until May 2024, with a composite endpoint of major adverse cardiovascular events (only NDLVC patients were followed). RESULTS: NDLVC patients exhibited better cardiac function than those with DCM, with higher LVEF (40.1%±15.8% vs 23.3%±8.8%, p<0.001). Compared with DCM, the presence of late gadolinium enhancement (LGE) was lower in the NDLVC group (77.4% vs 64.8%, p<0.001). NDLVC-REF showed a comparable prevalence of LGE presence with DCM (70.4% vs 77.4%, p=0.06) but lower LGE mass (4.8 (0, 9.9) g vs 6.8 (4.0, 11.0) g, p=0.01). Over a median follow-up of 83 months, 62 patients with NDLVC (29.5%) reached the composite endpoint. Multivariable analyses (forward logistic regression) identified right ventricular ejection fraction (RVEF) (0.98 (0.96, 0.99), p=0.01, Harrell's C-index=0.65) as the significant predictor of adverse outcomes in NDLVC. The presence of epicardium-involved LGE, left atrial volume index, LVEF, global radial strain and global circumferential strain was also associated with adverse events in NDLVC. In NDLVC-REF, RVEF <40% independently predicted major adverse cardiovascular events (2.19 (1.14-4.20), p=0.01). CONCLUSION: The clinical baseline and CMR parameters of NDLVC were different from those of DCM. RVEF was a powerful predictor of adverse events in NDLVC and NDLVC-REF.
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Zhuang et al. (2025) conducted a cohort in Non-dilated left ventricular cardiomyopathy (NDLVC) and dilated cardiomyopathy (DCM) (n=396). Non-dilated left ventricular cardiomyopathy (NDLVC) vs. Dilated cardiomyopathy (DCM) was evaluated on Composite endpoint of major adverse cardiovascular events. Right ventricular ejection fraction <40% independently predicted major adverse cardiovascular events in patients with NDLVC and reduced ejection fraction (2.19; 95% CI 1.14-4.20; p=0.01).
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