CMR Imaging-Based Risk Stratification for Patients with Dilated Cardiomyopathy and Severe Left Ventricular Dysfunction

Motivation: Dilated cardiomyopathy (DCM) patients with severely reduced left ventricular ejection fraction of≤35% face a high risk of sudden cardiac death and heart failure events. Goal(s): We aimed to refine a risk stratification model based on cardiac magnetic resonance imaging for DCM patients with LVEF≤35%, and to enhance clinical decision-making and ultimately, patient outcomes. Approach: A retrospective analysis was conducted on 1272 DCM patients divided into a development cohort and an internal validation cohort, as well as a prospective validation cohort (n=301).Results: Both LGE and LAVi are independently risk factors for predicting survival in a large cohort of patients with DCM and LVEF≤35%. Impact: Our novel risk stratification may assist in timely interventions such as implantation of implantable cardioverter-defibrillator, heart transplantation, implementation of left ventricular assist devices, or referral for HF specialty care, ultimately leading to improved outcomes for DCM patients with LVEF≤35%.