J Am Heart Assoc. 2026 Sep 24:e049783. doi: 10.1161/JAHA.126.049783. Online ahead of print.
ABSTRACT
BACKGROUND: The prevalence, anatomic distribution, enhancement patterns, and prognostic value of nonischemic late gadolinium enhancement (NI-LGE) in patients with prior myocardial infarction were not systematically investigated.
METHODS: A total of 948 patients (mean±SD age, 56.2±10.9 years; 88.4% men) diagnosed with prior myocardial infarction by cardiac magnetic resonance imaging were analyzed, excluding those with coexisting nonischemic cardiomyopathies or myocarditis. NI-LGE was defined as midwall or subepicardial enhancement. Competing risk analysis was performed to mitigate the influence of competing events.
RESULTS: Among these, NI-LGE was observed in 78 patients (8.2%), with septal involvement present in all cases. Lower left ventricular ejection fraction (odds ratio [OR]=0.97, P=0.01) and larger end-diastolic volume index (OR=1.01, P<0.001) were independently associated with NI-LGE. During a median follow-up of 69.6 months (interquartile range, 49.7-80.9 months), 99 (10.4%) and 63 (6.6%) experienced heart failure (HF)- and sudden cardiac death-related events, respectively. NI-LGE was associated with a markedly increased risk of HF-related events (subdistribution hazard ratio [sHR]=5.98, P<0.001) after adjusting for the confounders, but not sudden cardiac death (P=0.65). NI-LGE improved the model discrimination and fit performance (C-index: 0.84-0.87; likelihood ratio: 1168.0-1106.1, both P<0.001) for the HF-related events beyond left ventricular ejection fraction and late gadolinium enhancement extent. Moreover, NI-LGE involving both the septum and free wall conferred a higher risk of HF-related events than isolated septal involvement (sHR=2.42, P=0.02).
CONCLUSIONS: NI-LGE occurs in 8.2% of patients with prior myocardial infarction, predominantly involving the interventricular septum. As a potential marker of adverse remodeling, NI-LGE might provide incremental prognostic value for HF-related outcomes beyond traditional markers.
PMID:42786658 | DOI:10.1161/JAHA.126.049783