Heart Scar Location and Size Track Distinct Left Atrial Faults in Dilated Cardiomyopathy

Scar tissue in the heart’s main pumping chamber appears to leave measurable fingerprints on the left atrium. A multicenter cardiac magnetic resonance study of 816 patients with dilated cardiomyopathy has found that the location and extent of late gadolinium enhancement, a magnetic resonance imaging marker of myocardial fibrosis, are each independently associated with distinct phases of left atrial dysfunction. The findings, published in BMC Medical Imaging, suggest that where scar sits in the left ventricle may matter as much as how much of it there is when it comes to atrial mechanics.

Late gadolinium enhancement imaging, in which gadolinium contrast highlights areas of fibrosis or scar, is an established prognostic marker in patients with dilated cardiomyopathy. However, the influence of scar characteristics on left atrial function has remained unclear, and the study was designed to investigate this association using cardiac magnetic resonance.

The research team, led by Yiyuan Gao, Chengbin He and colleagues across multiple centers, retrospectively analyzed cardiac magnetic resonance scans from 816 patients with dilated cardiomyopathy acquired between June 2010 and June 2024. Using a technique called cardiac magnetic resonance feature tracking, they quantified three left atrial strain parameters: reservoir strain, conduit strain and booster strain. The location, extent and pattern of late gadolinium enhancement were assessed from LGE imaging.

Late gadolinium enhancement was present in 442 of the 816 patients, or 54.2 percent. When the researchers stratified patients by the location, extent and pattern of enhancement, left atrial strain parameters differed significantly across all groupings, with P values below 0.05 for each comparison. This initial signal indicated that scar characteristics and atrial mechanics travel together, but the team then applied sequential multivariable regression models to determine which associations held up after accounting for clinical and cardiac magnetic resonance parameters.

After adjustment, all three strain measures were independently associated with scar location. The beta coefficients were -2.097 for reservoir strain, -0.784 for conduit strain and -1.313 for booster strain, with all confidence intervals excluding zero and all P values below 0.05. In other words, the position of fibrosis within the left ventricle carried information about impairment across all three measured atrial strain phases.

Scar extent told a narrower story. Only conduit strain was independently associated with the amount of enhancement, with a beta coefficient of 0.675 (95 percent confidence interval 0.261 to 1.089, P = 0.001). The investigators then mutually adjusted for both LGE location and extent. In this stricter analysis, location remained independently associated with reservoir strain (beta = -1.957, 95 percent confidence interval -3.613 to -0.301, P = 0.021) and booster strain (beta = -1.698, 95 percent confidence interval -2.883 to -0.514, P = 0.005), while extent remained independently associated with conduit strain (beta = 0.596, 95 percent confidence interval 0.111 to 1.081, P = 0.016).

One scar characteristic did not survive scrutiny. The study found no consistent independent association between left atrial strain parameters and the pattern of late gadolinium enhancement, meaning that the distribution type of fibrosis added no reliable independent information about atrial mechanics in these models.

The authors conclude that in dilated cardiomyopathy, scar location and extent show distinct associations with the atrium’s phasic mechanics: location is consistently tied to impaired reservoir strain, whereas extent is tied to conduit strain. As a retrospective observational study, the work demonstrates associations rather than causal effects, and the patient cohort underwent scanning over a fourteen-year window at multiple centers. Nevertheless, the results indicate that routine cardiac magnetic resonance measures of fibrosis could offer a window into left atrial dysfunction in this population, complementing the established prognostic role of late gadolinium enhancement in dilated cardiomyopathy.

Subject of Research: Association between late gadolinium enhancement characteristics and left atrial dysfunction in dilated cardiomyopathy assessed by cardiac magnetic resonance

Article Title: Association of late gadolinium enhancement characteristics with left atrial dysfunction in dilated cardiomyopathy: a multicenter cardiac magnetic resonance study

Article References: Gao, Y., He, C., Li, Q., Zhao, X., Shi, J., Li, W., Liu, W., Wang, X., Tan, R.-S., Ma, S., Hu, X., Zeng, Q., Zhong, L., Hu, H., & Xu, M. (2026). Association of late gadolinium enhancement characteristics with left atrial dysfunction in dilated cardiomyopathy: a multicenter cardiac magnetic resonance study. BMC Medical Imaging. https://doi.org/10.1186/s12880-026-02982-0

Image Credits: AI Generated

DOI: 10.1186/s12880-026-02982-0

Keywords: dilated cardiomyopathy, late gadolinium enhancement, left atrial strain, cardiac magnetic resonance, feature tracking, myocardial fibrosis, reservoir strain, conduit strain, booster strain, multicenter study, Association, late