ETD

• Cardiac magnetic resonance
• CMR
• genetic background
• GLS
• india-ink
• late gadolinium enhancement
• LGE
• myocardial dysfunction
• myocardial strain
• NDLVC
• Non-dilated left ventricular cardiomyopathy

Non-dilated left ventricular cardiomyopathy (NDLVC) encompasses a heterogeneous spectrum of conditions that differ substantially in clinical presentation, etiology, and natural history. Identifying factors that enable early detection and characterization of structural features with prognostic relevance is crucial to optimize follow-up and risk stratification. In this cohort of NDLVC patients, we evaluated the role of cardiac magnetic resonance (CMR)-derived parameters, including wall motion abnormalities, the “India ink” sign, late gadolinium enhancement (LGE), and the emerging parameter of myocardial strain. Approximately half of the patients showed reduced ejection fraction, while most demonstrated structural or functional CMR abnormalities: the “India ink” sign was observed in 77.2% of cases, LGE in 89.2%, and strain alterations in 72.4%. CMR-derived myocardial strain proved highly sensitive for detecting subclinical myocardial dysfunction, even in patients with preserved ejection fraction, and correlated with wall motion abnormalities, increased LV mass, and fibro-fatty changes, showing a weak but significant association with fibrosis extent. When genetic data were considered, only the presence and extent of LGE—particularly when involving more than three segments—were significantly linked to genetic positivity and pathogenic variants. These findings highlight the diagnostic and prognostic value of CMR-derived strain in NDLVC and, most importantly, support the integration of tissue characterization, functional quantification, and genetic data for a precise and individualized evaluation of patients with non-dilated left ventricular cardiomyopathy.