Absence of Fibrosis Influences Prognosis of Cardiac Resynchronization in Nonischemic Cardiomyopathy

doi:10.1016/j.jacadv.2026.103295

Heart failure & cardiomyopathiesMeta-analysis

Absence of Fibrosis Influences Prognosis of Cardiac Resynchronization in Nonischemic Cardiomyopathy

JACC AdvPublished 1 Oct 2026

systematic review and meta-analysis
observational studies
cardiac magnetic resonance before cardiac resynchronization therapy (CRT) implantation

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Authors' conclusion

In NICM patients undergoing CRT, the absence of LGE is strongly associated with greater echocardiographic response and very low arrhythmic risk. In this subgroup the incremental benefit of CRT with defibrillator over CRT-P may be limited.

Study context

Population: Patients with nonischemic cardiomyopathy (NICM) who underwent cardiac magnetic resonance before CRT implantationTen studies included · CRT response (9 studies) 831 · arrhythmic risk (6 studies) 745

Comparison: patients without late gadolinium enhancement (LGE) vs patients with LGE

Pooled result

Echocardiographic CRT response

Odds ratio

3.52

95% CI 2.54–4.88

P < 0.001

By group

patients without LGE78.7%

patients with LGE50.7%

patients without LGE vs patients with LGE

OR 3.52 (95% CI 2.54–4.88); P < 0.001

As reported in the abstract

Further pooled results

Outcome	Lower odds with patients without LGE ←→ Higher odds with patients without LGE	OR (95% CI)	P value
Ventricular arrhythmia (sustained ventricular tachycardia, appropriate implantable cardioverter-defibrillator therapy, resuscitated cardiac arrest, sudden death) · absence of LGE associated with much lower arrhythmic risk		0.06 (0.02–0.15)	P < 0.001
	0.050.21520Odds ratio (log scale)

Cumulative incidence

Outcome	patients without LGE	patients with LGE	Estimate	P value
Ventricular arrhythmia (sustained ventricular tachycardia, appropriate implantable cardioverter-defibrillator therapy, resuscitated cardiac arrest, sudden death) · significantly lower in LGE cases than LGE+ ones	0.8%	21.1%		P < 0.001

Ventricular arrhythmia (sustained ventricular tachycardia, appropriate implantable cardioverter-defibrillator therapy, resuscitated cardiac arrest, sudden death): abstract labels the groups 'LGE cases' vs 'LGE+ ones' for this result

Original publication

Absence of Fibrosis Influences Prognosis of Cardiac Resynchronization in Nonischemic Cardiomyopathy. JACC Adv. Published 1 October 2026. doi:10.1016/j.jacadv.2026.103295

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Summarised from the published abstract; every number is checked against it