{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T18:09:52Z","timestamp":1774634992805,"version":"3.50.1"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Health Commission of Sichuan Province Medical Science and Technology Program","award":["24WXXT10"],"award-info":[{"award-number":["24WXXT10"]}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82102022"],"award-info":[{"award-number":["82102022"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012542","name":"Sichuan Province Science and Technology Support Program","doi-asserted-by":"publisher","award":["2021YJ0242"],"award-info":[{"award-number":["2021YJ0242"]}],"id":[{"id":"10.13039\/100012542","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Dilated cardiomyopathy (DCM) is a major cause of heart failure and sudden cardiac death (SCD), with a 5-year survival rate of approximately 45%\u201350%. Current risk stratification is predominantly dependent on left ventricular ejection fraction (LVEF), which has limited sensitivity and specificity. Hence, more effective biomarkers should be used in late gadolinium enhancement (LGE)-negative patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 378 consecutive patients with LGE-negative DCM were enrolled from four hospitals between December 2016 and December 2022. Cardiac magnetic resonance imaging-derived strain parameters (global radial strain, global circumferential strain, and global longitudinal strain [GLS]) were assessed against the primary (SCD and related events) and secondary (heart failure, appropriate implantable cardioverter-defibrillator therapy) endpoints. Internal validation was performed using stratified bootstrap resampling with Harrell\u2019s optimism correction to report the optimism-corrected C-index. Data were accessed for research purposes from 15\/06\/2023\u201330\/12\/2023, and all records were de-identified prior to analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Over a median follow-up of 59.78 months, 35 (9.26%) and 72 (19.0%) patients presented with the primary and secondary endpoints, respectively. Based on the multivariate Cox analysis, GLS, LVEF, and age were independent prognostic factors. However, only GLS (HR\u2009=\u20091.37;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.041) remained significant in the LVEF &lt;20% subgroup. A model integrating GLS and LVEF had a better discrimination ability for SCD than LVEF strata alone (apparent C-index 0.756 vs 0.714,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). This advantage persisted after bootstrap internal validation (B\u2009=\u20091000; optimism-corrected C-index 0.754 vs 0.711, Holm adjusted\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.048). Further inclusion of age and New York Heart Association (NYHA) classification enhanced the model\u2019s performance (model 4): apparent C-index 0.801; optimism-corrected C-index 0.785).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>GLS is an independent predictor of SCD-related events in LGE-negative DCM. Incorporating GLS with conventional indicators such as age, NYHA classification, and LVEF significantly enhances prognostic discrimination and model robustness, indicating potential value for future clinical risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0345077","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T17:21:59Z","timestamp":1774632119000},"page":"e0345077","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic value of cardiac magnetic resonance\u2013derived global longitudinal strain in LGE-negative dilated 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ESC Guidelines for the management of cardiomyopathies","volume":"44","author":"E Arbelo","year":"2023","journal-title":"Eur Heart J"},{"issue":"14","key":"pone.0345077.ref002","doi-asserted-by":"crossref","first-page":"1807","DOI":"10.1161\/CIRCULATIONAHA.106.174287","article-title":"Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention","volume":"113","author":"BJ Maron","year":"2006","journal-title":"Circulation"},{"issue":"12","key":"pone.0345077.ref003","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1007\/s11886-019-1236-3","article-title":"Risk stratification for sudden cardiac death in non-ischaemic dilated cardiomyopathy","volume":"21","author":"M 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