Idiopathic dilated cardiomyopathy (DCM) is the most common isoform of non-ischaemic cardiomyopathy and is characterised by dilatation of LV chamber and systolic dysfunction, which leads to progressive heart failure and a high risk for fatal arrhythmias. Although clinical manifestations are similar, DCM is not a single stage of a disease spectrum but may include several undetermined aetiologies, such as chronic myocarditis, tachycardia-induced cardiomyopathy, drug-induced cardiomyopathy, alcoholic cardiomyopathy, undiagnosed cardiac sarcoidosis and end-stage hypertrophic cardiomyopathy.1 Despite therapeutic advances in heart failure, the mortality and morbidity of DCM remain high. Therefore, identifying high-risk patients who are most likely to benefit from early aggressive therapies constitutes a crucial part of patient management. Several factors, such as age, sex, New York Heart Association functional classes, LVEF, QRS duration, exercise capacity and several blood biomarkers, have been associated with adverse prognosis in patients with DCM. However, the prediction of long-term prognosis remains difficult because of diverse background disorders, as mentioned above.

Recent advances in cardiac MR (CMR) imaging have enabled us to assess cardiac morphology, function and tissue characteristics both in ischaemic and non-ischaemic cardiomyopathies. Table 1 shows the different CMR sequences applied for the diagnosis and evaluation of DCM. CMR is now capable of identifying cardiac abnormalities not readily recognised by conventional imaging modalities.1 Among several techniques of MRI sequences, late gadolinium enhancement (LGE)-CMR relies on the delivery of intravenous gadolinium chelate to …