Objectives Currently risk stratification of patient with non-ischaemic dilated cardiomyopathy (DCM) is mainly based on clinical profiles. Late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR) may improve patient selection in receiving intensive treatment. The purpose of this study was to examine if LGE provide incremental value in risk stratification for DCM patients.

Methods A retrospective cohort study was undertaken in 293 DCM patients. All patients underwent CMR investigation for LGE upon admission. Baseline demographic data and echocardiography assessment were obtained shortly after admission.

Results Of 293 DCM patients, 49.5% (n = 145) had LGE, 50.5% (n = 148) had no-LGE. Among the baseline variables, male (OR 2.634, P = 0.008) and disease duration (OR 1.080, P = 0.007) were independent predictors of LGE. With follow-up 3.2 years, patients with LGE had higher all-cause mortality than patients without LGE (21.4% vs. 9.5%, P < 0.001). Patients with LGE were further sub-grouped by the location of LGE. 61 patients had LGE in ventricular septum (VS). 73 patients had LGE in the location other than VS and 11 patients had LGE in both septal and non-septal location (diffuse-LGE). There was a significant difference in all-cause mortality rate among the three subgroups and no-LGE (VS-LGE 19.7%, Other than VS-LGE 20.5%, diffuse-LGE 36.4%, P < 0.001). Cox multivariate analysis showed that the presence of LGE, QRS duration and left atrium size were the independent predictors of all-cause mortality in DCM patients.

Conclusions LGE is an independent predictor of increased all-cause mortality and patients with diffuse-LGE were associated with higher risk for all-cause mortality in DCM patients.