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Final Program


Program-At-A-Glance

Rapid Fire Session

Session: Rapid Fire Session 1: Tissue Characterization (Monitor 6)

Late Gadolinium Enhancement Predicts Incident Cardiovascular Events in Subclinical Idiopathic Nonischemic Cardiomyopathy

Thursday, February 5, 2026
10:22 AM - 10:29 AM  
Location: Galapagos / Aruba / Ilhabela (2nd Lower Level)
Background: Idiopathic nonischemic cardiomyopathy (iNICM) is a heterogeneous condition that may have a long preclinical phase. Imaging characteristics that predict cardiovascular outcomes are not well known.

Methods: We identified 196 patients with iNICM, without clinical HF (AHA/ACC Stage B heart failure) who underwent CMR for evaluation of suspected cardiomyopathy between January 2023 and May 2024. CMR consisted of serial bSSFP cine short-axis through the LV for evaluation of LV volumes and ejection fraction (LVEF), T1 mapping with calculation of extracellular volume, and late gadolinium enhancement (LGE) images. Prevalent LGE was noted, and LGE was quantified using a semi-automated technique (cvi42 v.6.2.1, Circle Cardiovascular Imaging) with a threshold set at 5SD of reference myocardium. Patients were followed for a mean of 10.9 ± 4.9 (max to 25) months for the composite outcome of incident heart failure (Stage C/D or HF hospitalization), and/or sustained arrhythmic events (VT or VF). Multivariable cox proportional hazards models were used to evaluate the association between LGE presence and event-free survival analysis.

Results: Among the 196 patients (age 57± 15 years, 39% female), LGE was present in 120 (61%). During follow-up, 34 patients (17%) developed incident HF, 15 (8%) experienced arrhythmia (VT, or VF), and 46 (23%) had a composite event. Patients who developed HF had significantly lower LVEF (p < 0.001), higher LV mass index (p = 0.07), greater indexed LV end-diastolic volume index (p = 0.03), and higher ECV (p = 0.001) (TABLE). On multivariable Cox regression adjusted for age, sex, LV mass index, LV end diastolic volume index, LV ejection fraction, and native T1, the presence of LGE remain significantly associated with incident cardiovascular event (HR 2.23, 95% CI 1.15-4.34 p = 0.01). Kaplan-Meier analysis demonstrated lower event-free survival among patients with LGE (log rank p = 0.01) (FIGURE).

Conclusion: For patients with idiopathic non-ischemic cardiomyopathy without clinical HF, the presence of LGE, likely indicating focal fibrosis, more than doubled the risk of a CVD event, independently of LV size, function, mass, or global parametric mapping.

TABLE. Clinical and CMR Characteristics Stratified by Incident CV events

Variable 

No CV event   

(n= 150) 

CV event 

(n= 46) 

Clinical variables 

Age, years 

56 ± 16 

59 ± 13 

Female sex 

61 (41%) 

16 (34%) 

Atrial Fibrillation  

17 (11%) 

9 (20%) 

Diabetes Mellitus  

12 (8%) 

6 (13%) 

Hyperlipidemia  

43 (29%) 

11 (24%) 

Hypertension  

48 (32%) 

14 (30%) 

CMR characteristics 

LV mass index, g/m2 

60 ± 15 

65 ±16  

LV end diastolic volume index, mL/m2 

94 ± 26 

106 ± 32  

LV ejection fraction, % 

52 ± 10  

44 ± 14 

LV native T1, ms 

1261 ± 47 

1272 ± 41  

ECV 

0.29 ± 0.04 

0.33 ± 0.05 

LGE presence 

88 (60%) 

32 (70%) 

LGE quantification*, g 

4.4 ± 5.6 

7 ± 7 

LV = left ventricular; T1 = native T1 mapping; ECV = extracellular volume; LA = left atrial; LGE = Late Gadolinium enhancement; HF = heart failure 

Values are presented as mean (SD) for continuous variables and count (%) for categorical variables.  

*LGE quantification is assessed using a threshold of 5 standard deviations. 
FIGURE. Kaplan-Meier Curve for Composite Cardiovascular Events by Late Gadolinium (LGE) Status. Composite event defined as cardiac arrest, new-onset HF, or sustained ventricular arrhythmia (VT/VF). * Adjusted for age, sex, LV mass index, LV end diastolic volume index, LV ejection fraction, and native T1