Key result
LGE progression in DCM linked to ~8.1-fold higher risk of arrhythmic death or sustained VT/VF.
Why the study?
Although late gadolinium enhancement is a robust prognostic marker in non-ischemic cardiomyopathies, its longitudinal evolution, determinants, and clinical implications in dilated cardiomyopathy and non-dilated left ventricular dysfunction remain incompletely defined.
Does late gadolinium enhancement progression on serial cardiac magnetic resonance predict cardiac death, sustained ventricular tachycardia, or ventricular fibrillation in patients with dilated cardiomyopathy and non-dilated left ventricular dysfunction?
Cohort (n=101)
No
Does late gadolinium enhancement progression on serial cardiac magnetic resonance predict cardiac death, sustained ventricular tachycardia, or ventricular fibrillation in patients with dilated cardiomyopathy and non-dilated left ventricular dysfunction?
In patients with DCM and NDLVD, LGE progression on serial CMR occurs in 19% of patients, correlates with high-risk genetic variants, and strongly predicts arrhythmic events better than baseline LGE burden.
Serial CMR detection of LGE progression may refine arrhythmic risk stratification in DCM/NDLVD; leaves open prospective validation before guiding therapy.
Background Late gadolinium enhancement (LGE) is a robust prognostic marker in non-ischemic cardiomyopathies, yet its longitudinal evolution and clinical implications remain incompletely defined. We aimed to quantify LGE progression over time and evaluate its determinants and prognostic value in dilated cardiomyopathy (DCM) and non-dilated left ventricular dysfunction (NDLVD). Methods We retrospectively identified patients with DCM/NDLVD referred to a tertiary cardiomyopathy center (2010–2025) who underwent two cardiac magnetic resonance (CMR) scans ≥1 year apart, including LGE quantification. LGE progression was defined as an annualized increase in LGE mass (ΔLGE) >3 g/year. The primary endpoint was a composite of cardiac death, sustained ventricular tachycardia, or ventricular fibrillation. Results Among 250 eligible patients, 101 had serial CMRs (age 51±14 years; 70% male, median time between CMRs of 4[1.5-6] years); 28% carried a pathogenic/likely pathogenic (LP/P) variant. Over a median interval of 4 [1.5-6] years, 19 patients (19%) showed LGE progression. At baseline, patients showing LGE progression exhibited higher NT-proBNP levels, larger LV end-diastolic volume index, and reduced LVEF. LGE progression correlated weakly with increasing left atrial volume index (ρ=0.216, p=0.030) but not with changes in biventricular size, function, or strain. High-risk LP/P variants and lower baseline LVEF independently predicted LGE progression (OR 6.28 and OR 0.92 per 1% LVEF increase). LGE progression was strongly associated with arrhythmic events (HR 8.12, p<0.001), whereas baseline LGE burden was not. Conclusions In DCM/NDLVD, LGE progression is observed in one-fifth of patients, correlates with high-risk LP/P variants and identifies a high-risk arrhythmic phenotype, outperforming baseline LGE burden. Serial CMR-based fibrosis tracking may refine risk stratification and inform personalized surveillance strategies.
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Bonanni et al. (2026) conducted a cohort in Dilated cardiomyopathy (DCM) and non-dilated left ventricular dysfunction (NDLVD) (n=101). Late gadolinium enhancement (LGE) progression (>3 g/year) vs. No LGE progression (≤3 g/year) was evaluated on Composite of cardiac death, sustained ventricular tachycardia, or ventricular fibrillation (HR 8.12, p=<0.001). LGE progression (>3 g/year) in DCM/NDLVD occurred in 19% of patients and strongly predicted cardiac death, sustained VT, or VF (HR 8.12, p<0.001).
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