| Summary: | Left atrial (LA) geometry and phasic functions are frequently impaired in non-ischaemic dilated cardiomyopathy (NIDCM). Cardiac magnetic resonance (CMR) can accurately measure LA function and geometry parameters. We sought to investigate their prognostic role in patients with NIDCM. We prospectively examined 212 patients with NIDCM (49 ± 14.2-year-old; 73.5% males) and 106 healthy controls. LA volumes, phasic functions, geometry, and fibrosis were determined using CMR. A composite outcome (cardiac death, ventricular tachyarrhythmias, heart failure hospitalization) was ascertained over a median of 26 months. LA phasic functions, sphericity index (LASI) and late gadolinium enhancement (LA-LGE) were considerably impaired in the diseased group (<i>p</i> < 0.001) and significantly correlated with impaired LV function parameters (<i>p</i> < 0.0001). After multivariate analysis, LA volumes, LASI, LA total strain (LA-ε<sub>t</sub>) and LA-LGE were associated with increased risk of composite outcome (<i>p</i> < 0.001). Kaplan–Meier analysis showed significantly higher risk of composite endpoint for LA volumes (all <i>p</i> < 0.01), LASI > 0.725 (<i>p</i> < 0.003), and LA-ε<sub>t</sub> < 30% (<i>p</i> < 0.0001). Stepwise Cox proportional-hazards models demonstrated a considerable incremental predictive value which resulted by adding LASI to LA-ε<sub>t</sub> (Chi-square = 10.2, <i>p</i> < 0.001), and afterwards LA-LGE (Chi-Square = 15.8; <i>p</i> < 0.0001). NIDCM patients with defective LA volumes, LASI, LA-LGE and LA-ε<sub>t</sub> had a higher risk for an outcome. LA-ε<sub>t</sub>, LASI and LA-LGE provided independent incremental predictive value for outcome.
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