Atherosclerosis is associated with a worse prognosis in many diseases, but its impact in non-ischemic dilated cardiomyopathy (NIDCM) is not known. This study investigated the prognostic value of coronary atherosclerotic burden, as measured by Gensini score, in a cohort of NIDCM patients.

139 patients with left ventricular (LV) dysfunction due to NIDCM were classified according to both invasive coronary angiography (ICA) and cardiovascular magnetic resonance (CMR) imaging data in 3 subtypes of NIDCM: true NIDCM, NIDCM with bystander coronary artery disease (CAD) and NIDCM with bystander myocardial infarction (MI). Percentage, extent, location of fibrosis was assessed with CMR and coronary atherosclerotic burden by calculating Gensini score. Primary endpoint was a composite of cardiovascular mortality, non-fatal MI and revascularization by percutaneous coronary intervention (PCI).

Out of 139 patients (mean age 59.4±14.7 years old, 74% male), there were 101 patients (73%) with true NIDCM, 30 patients (22%) with NIDCM and bystander MI and 8 patients (5%) with NIDCM and bystander MI. 6 patients (4.3%) died and 6 (4.3%) underwent PCI during a median follow-up of 34.2±18 months. Gensini score predicted primary composite endpoint, in univariate and multivariate analysis, hazard ratio=1.08, confidence interval 95% (1.034-1.13) P=0.001, as well as a history of CAD, LV ejection fraction (LVEF) and age (P<0.02, P=0.008 and P=0.024 respectively) (Figure 1).

Coronary atherosclerotic burden, as measured by Gensini score, is a new prognostic factor in NIDCM. Assessing this parameter improves risk-stratification and could be used to help personalize treatment in this population.