ArticlePloS one2026
Prognostic value of cardiac magnetic resonance-derived global longitudinal strain in LGE-negative dilated cardiomyopathy.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDilated cardiomyopathy (DCM) is a major cause of heart failure and sudden cardiac death (SCD), with a 5-year survival rate of approximately 45%-50%. Current risk stratification is predominantly dependent on left ventricular ejection fraction (LVEF), which has limited sensitivity and specificity. Hence, more effective biomarkers should be used in late gadolinium enhancement (LGE)-negative patients.
methodsA total of 378 consecutive patients with LGE-negative DCM were enrolled from four hospitals between December 2016 and December 2022. Cardiac magnetic resonance imaging-derived strain parameters (global radial strain, global circumferential strain, and global longitudinal strain [GLS]) were assessed against the primary (SCD and related events) and secondary (heart failure, appropriate implantable cardioverter-defibrillator therapy) endpoints. Internal validation was performed using stratified bootstrap resampling with Harrell's optimism correction to report the optimism-corrected C-index. Data were accessed for research purposes from 15/06/2023-30/12/2023, and all records were de-identified prior to analysis.
resultsOver a median follow-up of 59.78 months, 35 (9.26%) and 72 (19.0%) patients presented with the primary and secondary endpoints, respectively. Based on the multivariate Cox analysis, GLS, LVEF, and age were independent prognostic factors. However, only GLS (HR = 1.37; P = 0.041) remained significant in the LVEF <20% subgroup. A model integrating GLS and LVEF had a better discrimination ability for SCD than LVEF strata alone (apparent C-index 0.756 vs 0.714, P < 0.001). This advantage persisted after bootstrap internal validation (B = 1000; optimism-corrected C-index 0.754 vs 0.711, Holm adjusted P = 0.048). Further inclusion of age and New York Heart Association (NYHA) classification enhanced the model's performance (model 4): apparent C-index 0.801; optimism-corrected C-index 0.785).
conclusionGLS is an independent predictor of SCD-related events in LGE-negative DCM. Incorporating GLS with conventional indicators such as age, NYHA classification, and LVEF significantly enhances prognostic discrimination and model robustness, indicating potential value for future clinical risk stratification.
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