Patterns of late gadolinium enhancement are associated with ventricular stiffness in patients with advanced non-ischaemic dilated cardiomyopathy

Aims: Despite the prognostic importance of ventricular filling and ventricular-arterial interaction in patients with advanced systolic heart failure, the structural determinants of these parameters have not been fully studied. We aimed to investigate whether patterns of late gadolinium enhancement (LGE) on cardiac magnetic resonance affect ventricular elastic properties or performance in patients with non-ischaemic dilated cardiomyopathy (DCM).Methods and results: Patients (n = 49) with markedly reduced systolic function (left ventricular (LV) ejection fraction <35%) due to longstanding non-ischaemic DCM underwent contrast-enhanced cardiac magnetic resonance after comprehensive echo-Doppler evaluations. The single beat-derived end-diastolic elastance, end-systolic elastance, arterial elastance, and dyssynchrony indices were measured by echo. On the basis of LGE patterns, patients could be divided into three groups: non-LGE (n = 18), non-midwall LGE (n = 13), and midwall LGE (n = 18). The midwall LGE group had lower LV systolic longitudinal velocity (4.6 ± 1.7 for non-LGE vs. 4.3 ± 1.2 for non-midwall LGE vs. 3.5 ± 1.0 cm/s for midwall LGE, P = 0.025), higher end-diastolic elastance index (0.41 ± 0.21 vs. 0.46 ± 0.31 vs. 0.85 ± 0.51 respectively, P = 0.008), and a more impaired ventriculoarterial coupling index (3.14 ± 1.53 vs. 2.88 ± 1.94 vs. 5.52 ± 3.18, P = 0.006) than other subgroups.Conclusion: Patients with midwall LGE had a higher ventricular stiffness index and more impaired ventriculoarterial coupling when compared with other non-ischaemic DCM patients.