Cor Vasa 2026, 68(3):265-272

Prognostic value of parametric mapping techniques for predicting left ventricular reverse remodeling in patients with dilated cardiomyopathy

Tatiana Štípalová^a-c, Mary Mojica-Pisciotti^b, Roman Panovský^a-c, Hana Poloczková^{a, c}, Věra Feitová^d, Tomáš Holeček^b-e, Michael Andrej^c, Jan Krejčí^{a, c}

^a 1st Internal Cardioangiology Department of St. Anne's University Hospital in Brno, Brno, the Czech Republic

^b International Clinical Research Center of St. Anne's University Hospital in Brno, Brno, the Czech Republic

^c Faculty of Medicine, Masaryk University, Brno, the Czech Republic

^d Clinic of Imaging Methods of St. Anne's University Hospital in Brno, Brno, the Czech Republic

^e Department of Biomedical Engineering, Brno University of Technology, Brno, the Czech Republic

Objective: The objective of this study was to evaluate the prognostic value of cardiac magnetic resonance (CMR) parameters, including late gadolinium enhancement (LGE) and parametric mapping (T1, T2, and extracellular volume fraction [ECV]), in combination with endomyocardial biopsy (EMB) findings, for predicting left ventricular reverse remodeling (LVRR) in DCM patients with definite, possible, or excluded inflammatory cardiomyopathy (ICM).

Methods: We retrospectively analyzed 87 patients with recently diagnosed dilated cardiomyopathy (RODCM) who underwent baseline CMR and EMB, and had a second CMR within 395 days. ICM was classified as definite, possible, or excluded based on EMB findings. LVRR was defined as an absolute increase in left ventricular ejection fraction (LVEF) >10% and a relative decrease in left ventricular end-diastolic volume (LVEDV) ≥10% at follow-up. Baseline clinical, EMB, and CMR parameters were evaluated using univariate and multivariate logistic regression to identify predictors of responder-defined LVRR.

Results: LVRR criteria were met by 40 patients (46%). Baseline LGE, LVSV >71.5 ml, and ECV were associated with lower odds of achieving LVRR on univariate analysis. Significant predictors of achieving responder-defined LVRR were identified in top-performing multivariate models with two and three predictors (LVSV >71.5 ml + ECV >29.6%; AUC 0.776 and ECV per-SD + LGE + LVSV >71.5 ml; AUC 0.785). Responders exhibited significantly greater improvements in LVEF and native T1 reduction from baseline to follow-up compared to non-responders.

Conclusion: In patients with RODCM, baseline ECV is a robust and independent predictor of responder-defined LVRR, outperforming native T1, T2, and EMB-derived inflammatory markers. A multiparametric CMR approach integrating diffuse fibrosis burden with ventricular size, volumes, and function provides optimal prognostic assessment of responder-defined LVRR.

Keywords: Cardiac magnetic resonance, Dilated cardiomyopathy, Endomyocardial biopsy, Extracellular volume, Left ventricular reverse remodeling, Parametric mapping

Received: January 26, 2026; Revised: January 26, 2026; Accepted: February 27, 2026; Prepublished online: June 2, 2012; Published: July 1, 2026  Show citation