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• Clinical Article •
Prediction of adverse cardiovascular events in patients with early-stage dilated cardiomyopathy using cardiac magnetic resonance-derived hemodynamic force parameters
LI Yuan  MA Liyuan  NIU Yuanyuan  LI Rui  MA Ning  ZHU Li 

Cite this article as: LI Y, MA L Y, NIU Y Y, et al. Prediction of adverse cardiovascular events in patients with early-stage dilated cardiomyopathy using cardiac magnetic resonance-derived hemodynamic force parameters[J]. Chin J Magn Reson Imaging, 2026, 17(10): 94-101. DOI:10.12015/issn.1674-8034.2026.10.011.


[Abstract] Objective To investigate the predictive value of cardiac magnetic resonance (CMR)-derived hemodynamic force (HDF) parameters for major adverse cardiovascular events (MACE) in patients with dilated cardiomyopathy (DCM) at New York Heart Association (NYHA) functional class I or Ⅱ.Materials and Methods A total of 92 DCM patients with NYHA class I/Ⅱ who underwent CMR examination at the General Hospital of Ningxia Medical University from January 2020 to October 2024 were retrospectively enrolled. Patients were stratified into the MACE group (n = 16) and non-MACE group (n = 76) according to MACE occurrence during follow-up. Image post-processing was performed using Medis software. Clinical baseline characteristics, left ventricular functional parameters, and HDF-derived indices were compared between the two groups. Multivariable Cox regression analysis was performed to identify independent risk factors for MACE. Sensitivity analyses with incremental adjustment for key covariates, including left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), and late gadolinium enhancement (LGE), were conducted to verify the prognostic robustness of the lateral-septal pressure gradient integral (L-S). Considering the limited number of events, Firth's bias-reduced Cox regression was applied to minimize small-sample estimation bias. Internal validation based on 1000 bootstrap resamples was performed to calculate the optimism-corrected Harrell's C-index. The Maxstat method was used to determine the optimal cut-off value of L-S for MACE prediction. Kaplan-Meier survival curves were plotted to assess cumulative event-free survival, and the log-rank test was used to compare inter-group survival differences and validate the risk-stratification efficacy of L-S.Results The MACE group had a significantly higher proportion of male patients than the non-MACE group (Fisher's exact test, P = 0.002). After adjustment for sex and age, multivariable Cox regression analysis demonstrated that L-S was significantly associated with MACE (HR = 1.726, 95% CI: 1.033 to 2.884, P = 0.037), with a C-index of 0.755. Firth's penalized Cox regression further confirmed the stable prognostic effect of L-S (HR = 1.739, P = 0.037), consistent with the standard Cox model. Bootstrap internal validation yielded an optimism-corrected C-index of 0.725 with an optimism of only 0.03, indicating a low risk of overfitting. Sensitivity analyses adjusting sequentially for LVEF, LVEDV, and LGE confirmed no reversal of the effect direction for the prognostic association of L-S (HR range: 1.590 to 1.726). In the male subgroup, the optimal cut-off value of L-S was 1.78. Patients with L-S > 1.78 showed a significantly higher cumulative incidence of MACE compared with those with L-S ≤ 1.78 (log-rank P < 0.05).Conclusions L-S may serve as a potential imaging biomarker for prognostic evaluation in patients with early-stage DCM. An L-S threshold of 1.78 may help identify high-risk male patients with early-stage DCM, providing a potential imaging reference for individualized risk assessment. However, these findings require further validation in multicenter cohorts.
[Keywords] dilated cardiomyopathy；magnetic resonance imaging；cardiac magnetic resonance；hemodynamic force；prognosis；risk stratification

LI Yuan1   MA Liyuan2   NIU Yuanyuan2   LI Rui1   MA Ning1   ZHU Li2*  

1 The First Clinical Medical College of Ningxia Medical University, Yinchuan 750004, China

2 Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan 750004, China

Corresponding author: ZHU L, E-mail: zhuli72@163.com

Conflicts of interest   None.

Received  2026-08-01
Accepted  2026-09-22
DOI: 10.12015/issn.1674-8034.2026.10.011
Cite this article as: LI Y, MA L Y, NIU Y Y, et al. Prediction of adverse cardiovascular events in patients with early-stage dilated cardiomyopathy using cardiac magnetic resonance-derived hemodynamic force parameters[J]. Chin J Magn Reson Imaging, 2026, 17(10): 94-101. DOI:10.12015/issn.1674-8034.2026.10.011.

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