OBJECTIVES: We investigated the prognostic role of myocardial fibrosis by 
delayed enhancement (DE) cardiovascular magnetic resonance (CMR) in nonischemic 
dilated cardiomyopathy (NICM) patients with no or mild symptoms of heart failure 
(HF).
METHODS: A prospective cohort of 125 NICM patients (82 males, age 59±14years, 
mean±SD) with echocardiographic evidence of left ventricular (LV) systolic 
dysfunction (mean ejection-fraction 33±10%), without (stage B) or with history 
of mild HF symptoms (stage C, NYHA classes I-II) was enrolled. The end-point was 
a composite of cardiac death and HF hospitalization.
RESULTS: Fifty (40%) patients showed myocardial DE, representing 12±7% of LV 
mass. During a median follow-up of 14.2months, 16 (32%) patients with DE 
experienced a composite event versus only 6 (8%) patients without DE 
(Kaplan-Meier survival curve, p=0.001). After correction for age, CMR-derived LV 
and right ventricular volumes, echocardiographic measurements of LV diastolic 
function and Doppler-estimated systolic pulmonary artery pressure, the presence 
of DE remained a strong and independent predictor of cardiac death or HF 
hospitalization (hazard ratio: 5.32, 95% confidence intervals 1.60 to 17.63, 
p=0.006).
CONCLUSIONS: In NICM patients with no or mild HF symptoms, the presence of 
myocardial DE is a strong predictor of worse clinical outcome even after 
correction for other established prognostic determinants. Contrast-enhanced CMR 
may be useful in prognostic stratification from the early stages of NICM.