Longitudinal assessment of late gadolinium enhancement progression in non-ischemic left ventricular dysfunction
F Bonanni, G Todiere, I Bellisario, I Gueli, A Aimo, C Grigoratos, C De Gori, M Muca, N Botto, S Vittorini, F Ricci, M Emdin, A Giannoni, A Clemente, A BarisonAbstract
Background
Late gadolinium enhancement (LGE) is a robust prognostic marker in non-ischemic cardiomyopathies, yet its longitudinal evolution and clinical implications remain incompletely defined. We aimed to quantify LGE progression over time and evaluate its determinants and prognostic value in dilated cardiomyopathy (DCM) and non-dilated left ventricular dysfunction (NDLVD).
Methods
We retrospectively identified patients with DCM/NDLVD referred to a tertiary cardiomyopathy center (2010–2025) who underwent two cardiac magnetic resonance (CMR) scans ≥1 year apart, including LGE quantification. LGE progression was defined as an annualized increase in LGE mass (ΔLGE) >3 g/year. The primary endpoint was a composite of cardiac death, sustained ventricular tachycardia, or ventricular fibrillation.
Results
Among 250 eligible patients, 101 had serial CMRs (age 51±14 years; 70% male, median time between CMRs of 4[1.5-6] years); 28% carried a pathogenic/likely pathogenic (LP/P) variant. Over a median interval of 4 [1.5-6] years, 19 patients (19%) showed LGE progression. At baseline, patients showing LGE progression exhibited higher NT-proBNP levels, larger LV end-diastolic volume index, and reduced LVEF. LGE progression correlated weakly with increasing left atrial volume index (ρ=0.216, p=0.030) but not with changes in biventricular size, function, or strain. High-risk LP/P variants and lower baseline LVEF independently predicted LGE progression (OR 6.28 and OR 0.92 per 1% LVEF increase). LGE progression was strongly associated with arrhythmic events (HR 8.12, p<0.001), whereas baseline LGE burden was not.
Conclusions
In DCM/NDLVD, LGE progression is observed in one-fifth of patients, correlates with high-risk LP/P variants and identifies a high-risk arrhythmic phenotype, outperforming baseline LGE burden. Serial CMR-based fibrosis tracking may refine risk stratification and inform personalized surveillance strategies.