**Left Ventricular Geometry and Replacement Fibrosis Detected by cMRI Are Associated with Major Adverse Cardiovascular Events in Nonischemic Dilated Cardiomyopathy**

**Bianca Olivia Cojan-Minzat 1,2, Alexandru Zlibut 1, Ioana Danuta Muresan 1, Carmen Cionca 3, Dalma Horvat 1, Eva Kiss 1, Radu Revnic 2, Mira Florea 2, Razvan Ciortea 1,4 and Lucia Agoston-Coldea 1,3,5,\***


Received: 7 May 2020; Accepted: 22 June 2020; Published: 25 June 2020

**Abstract:** To investigate the relationship between left ventricular (LV) long-axis strain (LAS) and LV sphericity index (LVSI) and outcomes in patients with nonischemic dilated cardiomyopathy (NIDCM) and myocardial replacement fibrosis confirmed by late gadolinium enhancement (LGE) using cardiac magnetic resonance imaging (cMRI), we conducted a prospective study on 178 patients (48 ± 14.4 years; 25.2% women) with first NIDCM diagnosis. The evaluation protocol included ECG monitoring, echocardiography and cMRI. LAS and LVSI were cMRI-determined. Major adverse cardiovascular events (MACEs) were defined as a composite outcome including heart failure (HF), ventricular arrhythmias (VAs) and sudden cardiac death (SCD). After a median follow-up of 17 months, patients with LGE+ had increased risk of MACEs. Kaplan-Meier curves showed significantly higher rate of MACEs in patients with LGE+ (*p* < 0.001), increased LVSI (*p* < 0.01) and decreased LAS (*p* < 0.001). In Cox analysis, LAS (HR = 1.32, 95%CI (1.54–9.14), *p* = 0.001), LVSI [HR = 1.17, 95%CI (1.45–7.19), *p* < 0.01] and LGE+ (HR = 1.77, 95%CI (2.79–12.51), *p* < 0.0001) were independent predictors for MACEs. In a 4-point risk scoring system based on LV ejection fraction (LVEF) < 30%, LGE+, LAS > −7.8% and LVSI > 0.48%, patients with 3 and 4 points had a significantly higher risk for MACEs. LAS and LVSI are independent predictors of MACEs and provide incremental value beyond LVEF and LGE+ in patients with NIDCM and myocardial fibrosis.

**Keywords:** nonischemic dilated cardiomyopathy; cardiac magnetic resonance imaging; late gadolinium enhancement; long axis strain; left ventricle sphericity index; major adverse cardiovascular events
