Subendocardium-involved late gadolinium enhancement in non-ischemic dilated cardiomyopathy improves risk stratification of sudden cardiac death

doi:10.1093/ehjci/jeaf376

Heart failure & cardiomyopathies

Subendocardium-involved late gadolinium enhancement in non-ischemic dilated cardiomyopathy improves risk stratification of sudden cardiac death

Eur Heart J Cardiovasc ImagingPublished 5 Jan 2026retrospective

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Authors' conclusion

SCD was predicted by both lateral subendocardium-involved LGE and septal mid-wall LGE in DCM. The novel SCD risk model integrating these phenotypes demonstrated superior prognostic performance compared with conventional prognosticators.

Study context

Population: Dilated cardiomyopathy (DCM) patients who underwent cardiac MRImean age 46 ± 14 years, 78.7% men
Participants: 902 patients

Exposure: three-tier risk stratification model over left ventricular ejection fraction

Main finding

As reported in the abstract

Composite of:

SCD
Surrogate SCD events

· median follow-up of 77 months (IQR 40-92 months)

Patients experienced sudden cardiac death (SCD) events

51

5.7%

Observational data: associations, not effects.

Further findings

Outcome	← Lower risk vs lowest risk ←→ Higher risk vs lowest risk →	HR (95% CI)	P value
SCD events, independent predictors (multivariable analysis) — septal mid-wall LGE vs lowest risk	0.050.21520	3.59 (1.73–7.47)	P = 0.001
SCD events, independent predictors (multivariable analysis) — lateral subendocardium-involved LGE vs lowest risk	0.050.21520	3.07 (1.39–6.75)	P = 0.005
SCD events by three-tier risk stratification model — intermediate risk vs lowest risk	0.050.21520	4.8 (2.2–10.46)	P < 0.001
SCD events by three-tier risk stratification model — highest risk vs lowest risk	0.050.21520	10.71 (3.53–32.46)	P < 0.001
	0.050.21520Hazard ratio (log scale)

Late gadolinium enhancement (LGE) phenotypes observed

Subendocardium-involved LGE: 129 (14.3%)
Mid-wall LGE: 263 (29.1%)
Subendocardium-involved LGE predominantly involving the lateral wall: 65.1%
Mid-wall LGE predominantly involving the septal wall: 97.7%

Model discrimination and reclassification over left ventricular ejection fraction

C-statistic improvement: 0.23
Net reclassification improvement: 0.67
Integrative discrimination index: 0.27

All P < 0.05

Original publication

Subendocardium-involved late gadolinium enhancement in non-ischemic dilated cardiomyopathy improves risk stratification of sudden cardiac death. Eur Heart J Cardiovasc Imaging. Published 5 January 2026. doi:10.1093/ehjci/jeaf376

Read the original article ↗PubMed

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