Prognostic impact of late gadolinium enhancement granularity in non-ischemic dilated cardiomyopathy.

OBJECTIVES

We aimed to assess the additional prognostic value of the concept of "late gadolinium enhancement (LGE) granularity" in non-ischemic dilated cardiomyopathy (DCM) patients to predict all-cause death.

METHODS

Between 2008 and 2021, we conducted a bicentric retrospective study including all consecutive DCM patients referred for Cardiovascular Magnetic Resonance (CMR). The primary outcome was all-cause death. Cox regressions were performed to determine the prognostic value of LGE findings.

RESULTS

Of 1668 DCM patients recruited (age 52 ± 8 years, 54% male), 268 (16%) died after a median (interquartile range) follow-up of 9 (7-12) years. In DCM patients with LGE (N = 472), the LGE extent, the septal location, and its presence in multiple areas were independently associated with death after adjustment for all prognostic variables (adjusted hazard ratio (HR): 4.27, 95% CI: 2.22-8.22; HR: 5.74, 95% CI: 3.35-9.85; and HR: 4.38, 95% CI: 2.08-9.22 respectively; all p < 0.001). The LGE granularity model combining all these LGE features showed the best improvement in model discrimination and reclassification over traditional prognostic variables, including the left ventricular ejection fraction (LVEF) value (C-statistic improvement: 0.14; net reclassification improvement = 64.3%; integrative discrimination index = 29.0%; all p < 0.05).

CONCLUSION

In a large cohort of DCM patients, a LGE granularity model combining LGE extent, location and multiple areas had additional prognostic value above traditional prognostic variables including the LVEF value to predict all-cause death.

KEY POINTS: Question Assessment of late gadolinium enhancement (LGE) is recommended in non-ischemic dilated. cardiomyopathy (DCM) patients to stratify the risk of death, but other LGE characteristics are not currently considered. Findings The concept of "LGE granularity," including the extent, location, and number of areas, provides additional prognostic value, especially in predicting all-cause mortality. Clinical relevance "LGE granularity" could play a crucial role not only in guiding the decision to implant a defibrillator in DCM patients but also in providing more personalized management, such as enhanced cardioprotective treatments, for those with high-risk LGE characteristics.