A risk stratification algorithm integrating LGE corridors and high-risk genotypes outperformed LVEF ≤35% for predicting major ventricular arrhythmias (AUC 0.72 vs 0.57; P=0.001).
Cohort (n=925)
Yes
Does a risk stratification algorithm integrating LGE corridors and high-risk genotypes improve prediction of major ventricular arrhythmic events compared to LVEF ≤35% in patients with nonischemic dilated cardiomyopathy?
Integrating LGE corridors and high-risk genotypes provides superior arrhythmic risk stratification compared to the traditional LVEF ≤35% threshold in patients with nonischemic dilated cardiomyopathy.
Hazard Ratio: 1.25 (95% CI 1.11–1.42)
p-value: p=<0.001
BACKGROUND: Fibrosis assessed through late gadolinium enhancement (LGE) in cardiac magnetic resonance imaging and genetics have emerged as risk markers of ventricular arrhythmias in nonischemic dilated cardiomyopathy. Conduction corridors detected within LGE (ie, LGE corridors) have been associated with ventricular arrhythmias in ischemic cardiomyopathy. This study sought to evaluate major ventricular arrhythmic events (MVAs) according to the presence of LGE corridors combined with high-risk genotypes (HRGs) in nonischemic dilated cardiomyopathy. METHODS: We studied consecutive patients with nonischemic dilated cardiomyopathy from 22 European centers who had undergone genetic testing and cardiac magnetic resonance imaging. RESULTS: Among 925 patients (mean age, 54.5 years interquartile range, 43.7–63.9 years; 64% men; mean left ventricular ejection fraction, 37.6% 26.9%–44.8%; LGE in 24.3%), LGE corridors were present in 160 patients (17.3%), and HRG in 119 (12.9%). After a median follow-up of 5.4 years (interquartile range, 3.3–7.7), 95 patients (10.3%) experienced an MVA. In multivariable competing-risk analysis adjusted for left ventricular ejection fraction and extent of LGE, the number of LGE corridors and HRGs were independently associated with MVA (subdistribution hazard ratio, 1.25 95% CI, 1.11–1.42; P <0.001; and subdistribution hazard ratio, 2.28 95% CI, 1.32–3.96; P =0.003, respectively). An optimal cutoff of ≥4 LGE corridors predicted MVA. A stepwise risk stratification algorithm to predict MVA integrating LGE, the presence of ≥4 LGE corridors, and HRG outperformed left ventricular ejection fraction ≤35%–based classification proposed in guidelines (5-year time-dependent area under the curve, 0.72 95% CI, 0.65–0.78 versus 0.57 95% CI, 0.51–0.64; P =0.001), showing a progressive increase in arrhythmic risk across categories (Gray test P <0.001), and allowing clinically meaningful arrhythmic risk classification. CONCLUSIONS: LGE corridors and HRGs provide additive value for arrhythmic risk stratification in patients with nonischemic dilated cardiomyopathy. These findings support MVA multiparametric prediction over the traditional left ventricular ejection fraction ≤35% threshold.
“These results reinforce the need to move toward a personalized risk assessment in dilated cardiomyopathy, integrating clinical, genetic, and advanced cardiac imaging information into decision-making.”
Ramos et al. (2026) conducted a cohort in Nonischemic dilated cardiomyopathy (n=925). LGE corridors and high-risk genotypes vs. Absence of LGE corridors and high-risk genotypes was evaluated on Major ventricular arrhythmic events (MVAs) (HR 1.25, 95% CI 1.11-1.42, p=<0.001). A risk stratification algorithm integrating LGE corridors and high-risk genotypes outperformed LVEF ≤35% for predicting major ventricular arrhythmias (AUC 0.72 vs 0.57; P=0.001).