This research is Trending!
September 8, 2026Circulation
Arrhythmic Risk Stratification According to LGE Corridors and Genetics in Nonischemic Dilated Cardiomyopathy
Noemí RamosNerea Mora AyestaránJuan Pablo OchoaEduard ClaverCristina Gómez GonzálezEdwin PoelMónica García MonsalvoGuillem CasasCarmen Muñoz-EsparzaMaría Teresa Basurte-ElorzJosé M. Larrañaga-MoreiraJose M. Garcia-PinillaMaría V. MogollónGonzalo Cabezón VillalbaVictoria Espejo BaresM Ruiz-CuetoBernardo López-AbelAna García‐ÁlvarezVicente ClimentColoma TirónEva Cabrera‐BorregoMaria Luisa Peña-PeñaTomás Ripoll‐VeraEsther ZorioJavier SanaúElena Rodríguez‐GonzálezConnie R. BezzinaMaría Gallego‐DelgadoJosé F. Rodríguez-PalomaresAndrea Di MarcoMaría Ángeles EspinosaAhmad S AminPablo García‐PavíaJesus G. Mirelis
Key result
Algorithm integrating LGE corridors and high-risk genotypes outperforms LVEF ≤35% for predicting major ventricular arrhythmias.
- HR 1.25
- 95% CI 1.11-1.42
- P<0.001
- n=925
Why the study?
Although LGE corridors are linked to ventricular arrhythmias in ischemic cardiomyopathy, their value combined with high-risk genotypes for major ventricular arrhythmic events in nonischemic dilated cardiomyopathy required evaluation.
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?
Key Points
- To evaluate major ventricular arrhythmic event risk based on the presence of late gadolinium enhancement (LGE) corridors combined with high-risk genotypes in nonischemic dilated cardiomyopathy.
- Multicenter cohort study of consecutive patients with nonischemic dilated cardiomyopathy (N=925; mean age, 54.5 years; 64% men) from 22 European centers who underwent genetic testing and cardiac magnetic resonance imaging.
- Evaluated major ventricular arrhythmic events over a median follow-up of 5.4 years (interquartile range, 3.3–7.7 years) using multivariable competing-risk analysis adjusted for left ventricular ejection fraction and LGE extent.
- Major ventricular arrhythmic events occurred in 95 patients (10.3%), with the number of LGE corridors (sHR, 1.25 [95% CI, 1.11–1.42]; P < 0.001) and high-risk genotypes (sHR, 2.28 [95% CI, 1.32–3.96]; P = 0.003) independently associated with events.
- An optimal cutoff of ≥4 LGE corridors predicted arrhythmic events, and a risk algorithm integrating LGE, ≥4 corridors, and high-risk genotypes outperformed guidelines based on left ventricular ejection fraction ≤35% (5-year AUC, 0.72 [95% CI, 0.65–0.78] vs 0.57 [95% CI, 0.51–0.64]; P = 0.001).
Study Design
Type
Cohort (n=925)
Multicenter
Yes
Structured PICO
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?
P
Population
925 patients with nonischemic dilated cardiomyopathy who underwent genetic testing and cardiac MRI, followed for a median of 5.4 years.
E
Exposure
Risk stratification algorithm integrating late gadolinium enhancement (LGE), the presence of ≥4 LGE corridors, and high-risk genotypes (HRG)
C
Comparator
Left ventricular ejection fraction ≤35%-based classification proposed in guidelines
O
Outcome
Major ventricular arrhythmic events (MVAs)hard clinical
Main Result
Hazard Ratio: 1.25 (95% CI 1.11–1.42)
p-value: p=<0.001
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.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Although these findings will need to be confirmed in future studies and clinical trials, this work opens the door to new strategies for improving the prevention of ventricular arrhythmias and sudden cardiac death in this patient population.”
Implication
May refine arrhythmic risk assessment beyond LVEF in nonischemic dilated cardiomyopathy; hypothesis-generating and requires prospective validation before practice change.
Abstract
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.
Coverage & sources
Journal, society, and media accounts. Useful signal, not independent expert judgment.
Discussion
No takes yet. Share an insight, caveat, or question.
Cite This Study
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).