Prognostic Value of Multimodal Cardiac Magnetic Resonance Parameters in Patients with Nondilated Left Ventricular Cardiomyopathy and Reduced Left Ventricular Ejection Fraction

Background: To investigate the predictive value of cardiac magnetic resonance (CMR) feature parameters for major adverse cardiovascular events (MACEs) in patients with nondilated left ventricular cardiomyopathy and reduced left ventricular ejection fraction (NDLVC-rLVEF). Methods: This single-center retrospective study enrolled patients with NDLVC-rLVEF who underwent CMR between January 2015 and May 2025. MACEs included cardiovascular death, implantable cardioverter–defibrillator (ICD) discharge, and hospitalization due to heart failure or arrhythmia. Multivariable Cox regression analysis was used to identify independent risk factors for MACEs. Results: A total of 160 patients were included (mean age: 50.83 ± 15.81 years; 114 males, 46 females), with a median follow-up time of 53.00 months (IQR: 32.25–82.00). During this period, 41 patients (25.63%) experienced MACEs, including 10 cases of cardiovascular death, 1 case of ICD discharge, and 30 cases of rehospitalization due to heart failure or arrhythmia. Multivariable Cox regression analysis revealed that right ventricular ejection fraction (RVEF) and left ventricular global radial strain (LVGRS) were independent predictors of MACEs in patients with NDLVC-rLVEF. Kaplan–Meier analysis further demonstrated that patients with RVEF < 37% or LVGRS < 13% had a significantly higher incidence of MACEs (p < 0.05). Conclusions: Multimodal CMR parameters (RVEF and LVGRS) have significant predictive value for adverse prognosis in patients with NDLVC-rLVEF, facilitating early risk stratification and clinical intervention.