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LGE in Dilated Cardiomyopathy — EECC MCQ

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ModerateCardiac ImagingLGE in Dilated CardiomyopathyEECC

A 55-year-old man with dilated cardiomyopathy and LVEF 25% undergoes cardiac MRI. Late gadolinium enhancement imaging shows mid-wall linear LGE in the interventricular septum in a non-coronary distribution. What is the prognostic significance of this finding?

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Correct answer: D — Mid-wall LGE in DCM is an independent predictor of all-cause mortality and sudden cardiac death, regardless of LVEF

Mid-wall linear LGE in the interventricular septum is a characteristic and well-recognised pattern in non-ischaemic DCM, found in approximately 30% of cases. Multiple studies (CMR-GUIDE, others) have demonstrated that mid-wall LGE in DCM is an independent predictor of all-cause mortality, cardiovascular mortality, SCD, and appropriate ICD therapies, with prognostic value incremental to LVEF. The 2022 ESC VA/SCD Guidelines and 2023 ESC Cardiomyopathy Guidelines acknowledge LGE as a risk modifier for SCD that should be considered in ICD decision-making, particularly in patients with LVEF 35-50% (the 'grey zone' for primary prevention ICD). Ischaemic LGE follows a subendocardial-to-transmural pattern in a coronary territory, unlike this mid-wall pattern.

Reference: ESC (2022): Guidelines on Ventricular Arrhythmias and Prevention of Sudden Cardiac Death; ESC (2023): Guidelines on Cardiomyopathies