Prognostic Impact of Late Gadolinium Enhancement on Major Adverse Cardiovascular Events and Time‐Varying Attenuation of Risk in Dilated Cardiomyopathy

Figures

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  Figure 1. Flowchart shows patient inclusion. DCM, dilated cardiomyopathy.

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  Figure 2. Example MRI studies from a 43‐year‐old female patient hospitalized for heart failure 20 months post‐CMR. (A) LV function calculated from continuous cine short‐axis views. Maximum/minimum LA volumes were calculated using the biplane area‐length method, measuring LA area(orange outlines) and length (white lines) in (B) two‐chamber and (C) four‐chamber views at end‐systole, and in (D) two‐chamber and (E) four‐chamber views at end‐diastole. Global radial strain (GRS), global circumferential strain (GCS), and global longitudinal strain (GLS) were obtained by tracing endocardial(red) and epicardial(green) borders on (F) two‐chamber, (G) three‐chamber, and (H) four‐chamber long‐axis views, and on (I) cine short‐axis images throughout the cardiac cycle. Corresponding strain curves demonstrated GRS 19.07% (J), GCS −15.03% (K), and GLS −8.60% (L). LGE burden was quantified by tracing endocardial(red) and epicardial (green) borders on serial LV short‐axis LGE images (M−O). Regions with signal intensity > 5 SD above normal myocardium were defined as LGE. Yellow shading represents quantified LGE areas; blue circles delineate normal myocardium.

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  Figure 3. Dynamic curve of hazard ratio for LGE Extent. Shaded area = 95% CI; horizontal dashed line = HR1.0. Vertical dotted lines indicate 12, 24, and 30 months.

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  Figure 4. Receiver operating characteristic (ROC) curve for LGE extent predicting MACE. AUC = 0.809; red dot indicates the optimal cut‐off of 6.4%(sensitivity 0.652, specificity 1.000).

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  Figure 5. Kaplan‐Meier curve of mace events according to (A) late gadolinium enhancement present (LGE), (B) LGE percentage of LV mass.