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Mid-wall LGE Prognosis in DCM — EECC MCQ

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ModerateCardiomyopathyMid-wall LGE Prognosis in DCMEECC

A 50-year-old man with non-ischaemic DCM (LVEF 20%) is assessed for prognosis. CMR shows mid-wall linear LGE in the septum involving 18% of the LV myocardium. What is the prognostic significance of this LGE pattern?

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Correct answer: E — Mid-wall septal LGE in DCM is strongly associated with increased risk of SCD, sustained VT, and all-cause mortality, independent of LVEF — it may identify patients who benefit from ICD even at LVEF >35%

Mid-wall LGE in non-ischaemic DCM (characteristically linear, septal) is one of the strongest independent predictors of adverse outcomes: SCD, sustained VT/VF, all-cause mortality, and HF hospitalisation. The CMR-GUIDE trial and multiple observational studies demonstrate that LGE extent and presence are superior to LVEF alone for risk stratification. The 2023 ESC Cardiomyopathy Guidelines incorporate LGE as a risk modifier for ICD decisions in non-ischaemic DCM: (1) LVEF ≤35%: ICD is Class IIa (weaker than ischaemic — Class I); (2) LVEF 35-50% with extensive LGE: ICD may be considered (particularly with additional risk factors — NSVT, syncope, arrhythmogenic genotype). LGE extent ≥5% of LV mass is associated with significantly worse outcomes.

Reference: ESC (2023): Cardiomyopathies Guidelines; CMR-GUIDE Trial