Objective To investigate the application value of contrast delayed enhanced cardiac magnetic resonance imaging (DE-CMR) in evaluation of the prognosis of patients with aortic insufficiency (AI) after surgery. Methods The medical records of 48 patients with AI treated by surgery were retrospectively analyzed. According to the occurrence of gadolinium contrast delayed enhancement of DE-CMR before surgery, the patients were divided into the enhancement group and the non-enhancement group, and the data of the two groups were compared. All patients were followed up to March 2017, and the incidence of adverse prognosis was recorded and the predictors of adverse prognosis were analyzed. Results Of the 48 patients, 17 patients had delayed gadolinium enhancement (35.42%) and 31 patients did not have (64.48%). There were no significant differences between the two groups in gender, age, hypertension, diabetes and grade of cardiac function before surgery (P>0.05). Before surgery, the LVESD, LVEDD, left atrial anteroposterior diameter and the maximum left ventricular diameter of the enhancement group were greater than those of the non-enhancement group (P<0.05). During the follow-up, the probabilities of ventricular arrhythmia, heart function, cardiac function progressing to grade III-IV and death rates in the enhancement group (23.52%, 35.29%, 29.41%) were higher than those in the non-enhancement group (3.23%, 9.68%, 6.45%) (P<0.05). Cox proportional hazards model analysis showed that LVEDD, LVESD, left atrial anteroposterior diameter were independent predictors of adverse prognosis after AI surgery. Conclusion DE-CMR can provide more comprehensive imaging data for diagnosis of AI, and myocardial fibrosis identified by gadolinium delayed enhancement can predict the adverse prognosis.