Introduction: Delayed hyperenhancement in cardiac magnetic resonance imaging (MRI) is a marker of myocardial fibrosis in cardiomyopathy. We have previously shown that absence of delayed hyperenhancement in MRI is a predictor of improvement of left ventricular (LV) dysfunction in patients with recent-onset dilated cardiomyopathy. We hypothesized that the presence of myocardial fibrosis diagnosed from delayed hyperenhancement is a long term prognostic factor in patients with non-ischemic LV systolic dysfunction. Methods: A total of 79 patients (56.4짹13.5 years, 48 males) with non-ischemic LV systolic dysfunction (LV ejection fraction <35%, no significant coronary artery stenosis) were monitored for the occurrence of adverse cardiac events. Cardiac MRI was performed to assess the presence of delayed hyperenhancement, at the initial presentation. Cardiac events were defined as rehospitalization due to worsening of heart failure (HF), cardiac transplantation and death. Results: There were 37 patients without delayed hyperenhancement (Group 1) and 42 patients with delayed hyperenhancement (Group 2). The mean follow-up duration was 19짹10 months. There was 1 event (2.7%, 1 rehospitalization due to worsening of HF) in Group 1, and 13 events (30.9%, 1 death, 1 transplantation, 11 rehospitalizations due to worsening of HF) in Group 2. There was a significant difference in mean event-free survival between groups (38.9짹1.0 months vs 28.4짹2.7 months, p< 0.01). The Cox regression analysis revealed that the presence of delayed hyperenhancement was the most potent, independent predictor of cardiac events (H.R. 8.06, C.I. 1.03짹63.41, p<0.05). Conclusion: The presence of delayed hyperenhancement in cardiac MRI is a significant predictor of future cardiac events in patients with non-ischemic LV systolic dysfunction.