Association of late gadolinium enhancement characteristics with left atrial dysfunction in dilated cardiomyopathy: a multicenter cardiac magnetic resonance study

Left ventricular (LV) late gadolinium enhancement (LGE) characteristics are established prognostic markers in dilated cardiomyopathy (DCM), whereas their influence on left atrial (LA) function remains unclear. This study aimed to investigate the association between LGE characteristics and LA dysfunction in DCM using cardiac magnetic resonance (MR). This retrospective study included 816 DCM patients who underwent cardiac MR between June 2010 and June 2024. LA reservoir, conduit, and booster strain were obtained using cardiac MR feature tracking (MR-FT). LGE location, extent, and pattern were assessed by LGE imaging. Data were analyzed using one-way analysis of variance and sequential multivariable regression models. LGE was present in 442 (54.2%) patients with DCM. LA strain parameters differed significantly across groups stratified by LGE location, extent, and pattern (all P < 0.05). After adjustment for clinical and cardiac MR parameters, LA reservoir, conduit, and booster strain were independently associated with LGE location [β coefficient = -2.097 (95% CI: -3.507, -0.686), -0.784 (95% CI: -1.490, -0.078), and − 1.313 (95% CI: -2.325, -0.300); all P < 0.05], while only conduit strain was associated with LGE extent [β coefficient = 0.675 (95% CI: 0.261, 1.089), P = 0.001]. After mutual adjustment for LGE location and extent, LGE location remained independently associated with LA reservoir strain [β = −1.957 (95% CI: -3.613, -0.301); P = 0.021] and booster strain [β = -1.698 (95% CI: -2.883, -0.514); P = 0.005], whereas LGE extent remained independently associated with LA conduit strain [β = 0.596 (95% CI: 0.111, 1.081); P = 0.016]. No consistent independent association was observed between LA strain parameters and LGE pattern. In DCM, LGE location and extent showed distinct associations with LA phasic mechanics. LGE location was consistently associated with impaired LA reservoir strain, whereas LGE extent was associated with LA conduit strain. No consistent independent association was observed for LGE pattern.