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Peer-reviewedCC BYClinical cardiology

Prognostic Impact of Late Gadolinium Enhancement on Major Adverse Cardiovascular Events and Time‐Varying Attenuation of Risk in Dilated Cardiomyopathy

  • Liyuan Ma1
  • Yuan Li2
  • Huairong Zhang3
  • Yan Zheng3
  • Pei Wang3
  • Yuanyuan Niu2
  • Li Zhu2
  1. 1Ningxia Medical University General Hospital, Yinchuan, China.
  2. 2The First Clinical Medical College of Ningxia Medical University, Yinchuan, China.
  3. 3Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan, China.
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Abstract

Objectives

To investigate the prognostic value of late gadolinium enhancement (LGE) extent for major adverse cardiovascular events (MACE) in dilated cardiomyopathy (DCM) patients and characterize the dynamic pattern of its risk effect over time.Methods

We retrospectively enrolled patients who underwent Cardiac Magnetic Resonance (CMR) between 2020 and 2024, with MACE (cardiac death, heart failure re-hospitalization, or sustained ventricular arrhythmia) as the endpoint. Patients were stratified by MACE occurrence. Schoenfeld residual testing showed borderline deviation of the proportional hazards (PH) assumption for LGE extent (LV mass percentage). Thus, a time-dependent Cox model (Extended Cox PHs Model) with an LGE extent × follow-up time interaction term was built to assess dynamic hazard ratio changes, and independent MACE risk factors were identified.Results

Among 173 DCM patients (age 47 ± 15 years, 105 males), 46 (26.6%) experienced MACE after a mean follow-up of 27 ± 16 months. The time-dependent Cox model identified LGE extent (baseline HR: 1.243, 95% CI: 1.162-1.329, p < 0.001), the LGE extent × time interaction (HR: 0.993, 95% CI: 0.989-0.997, p = 0.001), and LV end-diastolic volume index (LVEDVi; HR = 1.008, 95% CI: 1.003-1.014, p = 0.001) as independent MACE predictors. Notably, the risk effect of LGE extent demonstrated time-dependent attenuation.Conclusion

LV LGE extent and LVEDVi independently predict MACE in DCM patients. The early prognostic value of LGE extent suggests a critical time window for early fibrosis intervention.

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Cite

BibTeXRIS
BibTeX
@article{ma2026prognostic,
  title = {{Prognostic Impact of Late Gadolinium Enhancement on Major Adverse Cardiovascular Events and Time‐Varying Attenuation of Risk in Dilated Cardiomyopathy}},
  author = {Liyuan Ma and Yuan Li and Huairong Zhang and Yan Zheng and Pei Wang and Yuanyuan Niu and Li Zhu},
  journal = {Clinical cardiology},
  year = {2026},
  month = oct,
  doi = {10.1002/clc.70506},
  url = {https://europepmc.org/article/PMC/PMC13717952},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Prognostic Impact of Late Gadolinium Enhancement on Major Adverse Cardiovascular Events and Time‐Varying Attenuation of Risk in Dilated Cardiomyopathy
AU  - Liyuan Ma
AU  - Yuan Li
AU  - Huairong Zhang
AU  - Yan Zheng
AU  - Pei Wang
AU  - Yuanyuan Niu
AU  - Li Zhu
PY  - 2026
DA  - 2026/10/29
JO  - Clinical cardiology
DO  - 10.1002/clc.70506
UR  - https://europepmc.org/article/PMC/PMC13717952
AB  - Objectives  To investigate the prognostic value of late gadolinium enhancement (LGE) extent for major adverse cardiovascular events (MACE) in dilated cardiomyopathy (DCM) patients and characterize the dynamic pattern of its risk effect over time.Methods  We retrospectively enrolled patients who underwent Cardiac Magnetic Resonance (CMR) between 2020 and 2024, with MACE (cardiac death, heart failure re-hospitalization, or sustained ventricular arrhythmia) as the endpoint. Patients were stratified by MACE occurrence. Schoenfeld residual testing showed borderline deviation of the proportional hazards (PH) assumption for LGE extent (LV mass percentage). Thus, a time-dependent Cox model (Extended Cox PHs Model) with an LGE extent × follow-up time interaction term was built to assess dynamic hazard ratio changes, and independent MACE risk factors were identified.Results  Among 173 DCM patients (age 47 ± 15 years, 105 males), 46 (26.6%) experienced MACE after a mean follow-up of 27 ± 16 months. The time-dependent Cox model identified LGE extent (baseline HR: 1.243, 95% CI: 1.162-1.329, p < 0.001), the LGE extent × time interaction (HR: 0.993, 95% CI: 0.989-0.997, p = 0.001), and LV end-diastolic volume index (LVEDVi; HR = 1.008, 95% CI: 1.003-1.014, p = 0.001) as independent MACE predictors. Notably, the risk effect of LGE extent demonstrated time-dependent attenuation.Conclusion  LV LGE extent and LVEDVi independently predict MACE in DCM patients. The early prognostic value of LGE extent suggests a critical time window for early fibrosis intervention.
SN  - 0160-9289
SN  - 1932-8737
ER  -