INTRODUCTION: Dilated cardiomyopathy (DCM) is associated with significant 
morbidity and mortality. Contrast-enhanced cardiac MRI (CE-CMR) can detect 
potentially prognostic myocardial fibrosis in DCM. We investigated the role of 
CE-CMR in New Zealand patients with DCM, both Maori and non-Maori, including the 
characteristics and prognostic importance of fibrosis.
METHODS: One hundred and three patients (mean age 58 ± 13, 78 male) referred for 
CMR assessment of DCM were followed for 660 ± 346 days. Major adverse cardiac 
events (MACE) were defined as death, infarction, ventricular arrhythmias or 
rehospitalisation. CE-CMR used cines for functional analysis, and delayed 
enhancement to assess fibrosis.
RESULTS: Myocardial fibrosis was present in 30% of patients, the majority of 
which was mid-myocardial (63%). Volumetric parameters were similar in patients 
with or without fibrosis. At 2 years patients with fibrosis had an increased 
rate of MACE (HR = 0.77, 95% CI 0.3-2.0). Patients with full thickness or 
subendocardial fibrosis had the highest MACE, even in the absence of CAD). More 
Maori had fibrosis on CE-CMR (40% vs. 28% for non-Maori), and the majority (75%) 
was mid-myocardial. Maori and non-Maori had similar outcomes (25% vs. 24% with 
events during follow-up).
CONCLUSIONS: DCM patients frequently have myocardial fibrosis detected on 
CE-CMR, the majority of which is mid-myocardial. Fibrosis is associated with 
worse outcome in the medium term. The information obtained using CE-CMR in DCM 
may be of incremental clinical benefit.