Heart failure & cardiomyopathiesCohort study
Subendocardium-involved late gadolinium enhancement in non-ischemic dilated cardiomyopathy improves risk stratification of sudden cardiac death
- retrospective
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
patients experienced sudden cardiac death (SCD) events
51 (5.7%)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| SCD events, independent predictors (multivariable analysis) — septal mid-wall LGE vs lowest risk | 3.59 (1.73–7.47) | P = 0.001 | |
| SCD events, independent predictors (multivariable analysis) — lateral subendocardium-involved LGE vs lowest risk | 3.07 (1.39–6.75) | P = 0.005 | |
| SCD events by three-tier risk stratification model — intermediate risk vs lowest risk | 4.8 (2.2–10.46) | P < 0.001 | |
| SCD events by three-tier risk stratification model — highest risk vs lowest risk | 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
Summarised from the published abstract; every number is checked against it