Key result
Late gadolinium enhancement extent was associated with increased all-cause death in patients with ILVD (HR 1.38; 95% CI 1.06-1.78) and DCM (HR 1.39; 95% CI 1.06-1.83) over a median 9 years.
Why the study?
The prognostic value of late gadolinium enhancement findings in isolated left ventricular dilatation and dilated cardiomyopathy was not well established.
Do late gadolinium enhancement findings on CMR predict all-cause death in patients with isolated left ventricular dilatation and dilated cardiomyopathy?
Cohort (n=2,752)
Yes
Do late gadolinium enhancement findings on CMR predict all-cause death in patients with isolated left ventricular dilatation and dilated cardiomyopathy?
Late gadolinium enhancement characteristics, particularly extent, multiple areas, and septal location, provide independent and incremental prognostic value for mortality beyond traditional risk factors like LVEF in patients with ILVD and DCM.
LGE extent may refine mortality risk in ILVD; leaves open its incremental value in prospective models.
BACKGROUND Non-ischemic dilated cardiomyopathy (DCM) and isolated left ventricular dilatation (ILVD) are defined as left ventricular (LV) dilatation, with reduced or preserved left ventricular ejection fraction (LVEF), respectively. We aimed to assess the prognostic value of late gadolinium enhancement (LGE) findings, including LGE extent, location, and number of areas to predict all-cause death in ILVD and DCM, separately. METHODS Between 2008 and 2021, we conducted a bicentric retrospective study including all consecutive ILVD and DCM patients referred for cardiovascular magnetic resonance (CMR). The primary outcome was all-cause death. A propensity-score matching was performed to balance characteristics between ILVD and DCM populations. Cox regressions were performed to determine the prognostic value of each LGE feature. RESULTS Of 2,752 patients (age 52±8 years, 56% males), 408 (15%) patients died after a median (interquartile range) follow-up of 9 (7-12) years, including 268 (16%) of 1,668 DCM patients and 140 (13%) of 1,084 ILVD patients. Overall, 737 (27%) patients had LGE, including 472 (28%) of 1,668 DCM patients and 265 (24%) of 1,084 ILVD patients. After propensity-score matching, in ILVD patients with LGE (N=265), the LGE extent (hazard ratio [HR] 1.38, 95% confidence interval [CI]: 1.06-1.78, p=0.015), multiple LGE areas (HR=3.39, 95% CI: 1.66-6.92, p<0.001), and its septal location (HR=2.68, 95% CI: 1.59-4.52, p<0.001) were strong prognosticators of death after adjustment. Similarly, after propensity-score matching, in DCM patients with LGE (N=277), the LGE extent (HR=1.39, 95% CI: 1.06-1.83, p=0.018), multiple LGE areas (HR=2.70, 95% CI: 1.20-6.08, p=0.017), and its septal location (HR=2.82, 95% CI: 1.47-5.41, p=0.002) were strongly associated with death. The CMR LGE score performed well in participants with LGE (area under the curve [AUC] at 10 years, 0.79 [95% CI: 0.69-0.89]). CONCLUSIONS LGE findings were strongly and independently associated with death in both ILVD and DCM patients, with each successive LGE characteristic providing significant incremental prognostic value beyond traditional prognosticators, including LVEF.
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Gonçalves et al. (2026) conducted a cohort in Isolated left ventricular dilatation (ILVD) and non-ischemic dilated cardiomyopathy (DCM) (n=2,752). Late gadolinium enhancement (LGE) extent, location, and number of areas vs. Absence of LGE or different LGE characteristics was evaluated on All-cause death (HR 1.38, 95% CI 1.06-1.78, p=0.015). Late gadolinium enhancement extent was associated with increased all-cause death in patients with ILVD (HR 1.38; 95% CI 1.06-1.78) and DCM (HR 1.39; 95% CI 1.06-1.83) over a median 9 years.
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