The presence of late gadolinium enhancement (LGE) assessed by cardiac magnetic resonance imaging (CMR) is a strong prognosticators of death in patients with non-ischaemic dilated cardiomyopathy (DCM), defined as left ventricular (LV) dilation and left ventricular ejection fraction (LVEF)<50%. Although the current guidelines defined the concept of “isolated LV dilation” (ILVD) as LV dilation with preserved LVEF≥50%, the prognostic value of the “LGE granularity” is not established in this population.

To assess the prognostic value of the concept of “LGE granularity” including its extent, location, and pattern for predicting all-cause death above traditional prognosticators in patients with DCM or ILVD, separately.

Between 2008 and 2021, all consecutive patients with DCM and ILVD were included in two centres. The primary outcome was all-cause death. A propensity score matching was performed to balance characteristics in patients with DCM vs. those with ILVD.

Of 2752 patients analysed (age 52±8 years, 56% male), 15% patients died after a median follow-up of 9 (7–12) years. In the propensity-score matched population (n=1084 in DCM subgroup and n=1084 in ILVD), the LGE presence was associated with death (HR=2.98, 95%CI: 1.97–4.50, P<0.001). In ILVD patients with LGE (n=265), the LGE extent (HR=1.41, 95%CI: 1.09–1.83, P=0.009), the presence of LGE in multiple areas (HR=3.86, 95%CI: 1.73–8.61, P<0.001) and the septal location (HR=2.97, 95%CI: 1.37–6.46, P=0.006) were strong prognosticators of death after adjustment for traditional prognosticators. Similarly, in DCM patients with LGE (n=268), the LGE extent (HR=1.42, 95%CI: 1.07–1.89, P=0.014), the presence of LGE in multiple areas (HR=8.41, 95%CI: 3.32–21.3, P<0.001) and the septal location (HR=6.65, 95% CI: 3.02–14.6, P<0.001) were strongly associated with death (Figure 1).

The concept of “LGE granularity” was independently associated with all-cause death after adjustment for all traditional prognosticators in both DCM and ILVD.