Advanced Tissue and Functional Cardiac MRI Markers for Risk Stratification in Dilated Cardiomyopathy

Abstract

Dilated cardiomyopathy (DCM) is characterized by broad clinical heterogeneity, ranging from stable disease to rapid progression and arrhythmic events. Advanced cardiac magnetic resonance (CMR) techniques—including native T1 mapping, extracellular volume fraction (ECV), late gadolinium enhancement (LGE), and feature-tracking strain—provide unique insights into myocardial tissue composition and mechanical function.
Native T1 and ECV quantify diffuse interstitial fibrosis, while LGE detects replacement fibrosis; together, they refine risk assessment beyond conventional measures. Myocardial strain, including left ventricular (LV) global longitudinal strain (GLS) and left atrial (LA) reservoir strain, captures early mechanical dysfunction and offers independent prognostic value.
This review synthesizes current evidence on the prognostic utility of these biomarkers in DCM and highlights opportunities for multiparametric CMR integration into personalized risk stratification strategies.