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Updated: Dec 17, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Arrhythmic risk stratification by cardiac magnetic resonance tissue characterization: disclosing the arrhythmic
Aldostefano Porcari1, Antonio De Luca1, Chrysanthos Grigoratos2
1Cardiovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Via Pietro Valdoni 7, 34149, Trieste, Italy.
Insights
Sudden cardiac death risk stratification can be improved using cardiac magnetic resonance (CMR) imaging. CMR identifies cardiac fibrosis, a key factor in arrhythmias, offering better accuracy than current methods for selecting patients for defibrillator therapy.
Area of Science:
- Cardiology
- Medical Imaging
- Electrophysiology
Background:
- Sudden cardiac death (SCD) poses a significant global health challenge.
- Current risk stratification for implantable cardioverter defibrillator (ICD) therapy relies on left ventricular ejection fraction (LVEF) and functional status, with limited accuracy for specific cardiomyopathies.
- Existing risk scores offer suboptimal accuracy due to partial reflection of global arrhythmic risk.
Purpose of the Study:
- To evaluate the role of cardiac magnetic resonance (CMR) in identifying arrhythmic substrates for improved risk stratification.
- To explore CMR's ability to characterize myocardial tissue composition and identify fibrosis.
- To assess the prognostic value of CMR, including late gadolinium enhancement (LGE) and mapping techniques, in predicting major arrhythmic events.
Main Methods:
- Utilizing cardiac magnetic resonance (CMR) for comprehensive cardiac evaluation, including tissue characterization.
- Employing sequences before and after contrast administration, alongside mapping techniques, to analyze myocardial tissue composition.
- Assessing late gadolinium enhancement (LGE) as a marker for cardiac fibrosis and arrhythmic substrate.
Main Results:
- Cardiac magnetic resonance (CMR) provides detailed insights into myocardial tissue composition, identifying cardiac fibrosis as a significant arrhythmic substrate.
- Late gadolinium enhancement (LGE) on CMR is a strong prognostic marker for major arrhythmic events, independent of LVEF.
- CMR offers incremental prognostic value over traditional methods in both ischemic and non-ischemic cardiomyopathies.
Conclusions:
- Cardiac magnetic resonance (CMR) imaging, particularly through tissue characterization like LGE, enhances arrhythmic risk stratification.
- CMR's ability to disclose the arrhythmic substrate within the myocardium is crucial for personalized patient management.
- While mapping techniques show promise, further investigation and standardization are needed for their integration into clinical practice.
Abstract:
Sudden cardiac death (SCD) is a pivotal health problem worldwide. The identification of subjects at increased risk of SCD is crucial for the accurate selection of candidates for implantable cardioverter defibrillator (ICD) therapy. Current strategies for arrhythmic stratification largely rely on left ventricular (LV) ejection fraction (EF), mostly measured by echocardiography, and New York Heart Association functional status for heart failure with reduced EF. For specific diseases, such as hypertrophic and arrhythmogenic cardiomyopathy, some risk scores have been proposed; however, these scores take into account some parameters that are a partial reflection of the global arrhythmic risk and show a suboptimal accuracy. Thanks to a more comprehensive evaluation, cardiac magnetic resonance (CMR) provides insights into the heart muscle (the so-called tissue characterization) identifying cardiac fibrosis as an arrhythmic substrate. Combining sequences before and after administration of contrast media and mapping techniques, CMR is able to characterize the myocardial tissue composition, shedding light on both intracellular and extracellular alterations. Over time, late gadolinium enhancement (LGE) emerged as solid prognostic marker, strongly associated with major arrhythmic events regardless of LVEF, adding incremental value over current strategy in ischemic heart disease and non-ischemic cardiomyopathies. The evidence on a potential prognostic role of mapping imaging is promising. However, mapping techniques require further investigation and standardization. Disclosing the arrhythmic substrate within the myocardium, CMR should be considered as part of a multiparametric approach to personalized arrhythmic stratification.
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