BACKGROUND: Current guidelines recommend implantable cardioverter defibrillators for the primary prevention of sudden cardiac death (SCD) in patients with dilated cardiomyopathy with left ventricular ejection fraction (LVEF)≤35%. However, its effectiveness is hindered by the inability to reliably discriminate between the risk of SCD and competing death of heart failure deterioration, thereby limiting its clinical utility. We aimed to refine the SCD risk stratification model based on cardiac magnetic resonance imaging for patients with dilated cardiomyopathy with LVEF≤35%. METHODS: A total of 1272 patients with dilated cardiomyopathy with LVEF≤35% who underwent cardiac magnetic resonance imaging were consecutively enrolled in this study. The primary end point is a composite of SCD or aborted SCD and the second end point is a composite of heart failure death and heart transplantation. RESULTS: Over a median follow-up of 86.3 months, 101 patients reached the primary end point. In the adjusted analysis, age (hazard ratio [HR], 1.02 [95% CI, 1.01–1.04]; P =0.006) years, a family history of SCD (HR, 2.00 [95% CI, 1.01–3.98]; P =0.05), NT-proBNP (N-terminal pro-B-type natriuretic peptide) (HR, 2.02 [95% CI, 1.18–3.44]; P =0.01), LVEF (per 5% HR, 0.79 [95% CI, 0.66–0.95]; P =0.01), and late gadolinium enhancement≥7.5% (HR, 4.11[95% CI, 2.72–6.21]; P <0.001) were associated with SCD or aborted SCD. Left atrial volume index≥68.3 mL/m ² was an independent predictor of the secondary end point (adjusted HR, 1.65 [95% CI, 1.13–2.40]; P =0.009). Compared with late gadolinium enhancement<7.5%, patients with late gadolinium enhancement≥7.5% and LVEF≤20% had a 7.12-fold higher risk of experiencing SCD events in competing Cox analysis (annual event rate, 4.8%). CONCLUSIONS: Patients with dilated cardiomyopathy with late gadolinium enhancement≥7.5% were at heightened risk of SCD events, which can be used for risk assessment. Risk stratifications for SCD, combining clinical and cardiac magnetic resonance imaging may potentially guide decision-making for implantable cardioverter defibrillator therapy.

Objectives: Non-dilated left ventricular cardiomyopathy (NDLVC) is a novel cardiomyopathy characterised by normal LV size and non-ischaemic myocardial scarring or fatty tissue replacement. This study aimed to explore the clinical and cardiac magnetic resonance (CMR) characteristics of NDLVC compared with dilated cardiomyopathy (DCM) and event rates of patients with NDLVC and reduced LV ejection fraction (NDLVC-REF). Materials and methods: A retrospective cohort study of 396 patients, including 210 with NDLVC (135 classified as NDLVC-REF) and 186 with DCM, who underwent CMR imaging between 2015 and 2017, was conducted. Follow-up lasted until May 2024, with a composite endpoint of major adverse cardiovascular events (only NDLVC patients were followed). Results: NDLVC patients exhibited better cardiac function than those with DCM, with higher LVEF (40.1%±15.8% vs 23.3%±8.8%, p<0.001). Compared with DCM, the presence of late gadolinium enhancement (LGE) was lower in the NDLVC group (77.4% vs 64.8%, p<0.001). NDLVC-REF showed a comparable prevalence of LGE presence with DCM (70.4% vs 77.4%, p=0.06) but lower LGE mass (4.8 (0, 9.9) g vs 6.8 (4.0, 11.0) g, p=0.01). Over a median follow-up of 83 months, 62 patients with NDLVC (29.5%) reached the composite endpoint. Multivariable analyses (forward logistic regression) identified right ventricular ejection fraction (RVEF) (0.98 (0.96, 0.99), p=0.01, Harrell’s C-index=0.65) as the significant predictor of adverse outcomes in NDLVC. The presence of epicardium-involved LGE, left atrial volume index, LVEF, global radial strain and global circumferential strain was also associated with adverse events in NDLVC. In NDLVC-REF, RVEF <40% independently predicted major adverse cardiovascular events (2.19 (1.14–4.20), p=0.01). Conclusion: The clinical baseline and CMR parameters of NDLVC were different from those of DCM. RVEF was a powerful predictor of adverse events in NDLVC and NDLVC-REF.

With the growing demand for coronary artery visualization and the diagnosis of coronary artery disease, noninvasive coronary imaging modalities have gained significance. Coronary magnetic resonance angiography (CMRA) is a promising technique as it is noninvasive and does not involve ionizing radiation or iodinated contrast agents. Although certain limitations in this technology have prevented its application as a first-line clinical imaging modality, its immense developmental potential has positioned it as a focal point of research. This review discusses the advancements in CMRA across multiple technical domains—including motion correction, imaging acceleration, and integration with artificial intelligence—as well as its current clinical status and future prospects.