Left Ventricular Ring-like Pattern: The Arrhythmic Tale of a Scarred Heart

Cardiac magnetic resonance (CMR) imaging provides significant advantages in the non-invasive diagnosis of cardiac diseases. An emerging phenotype is increasingly being described in CMR reports, the LGE "ring-like" pattern, which resembles a circumferential/semi-circumferential LV scar. Different conditions exhibit this fibrosis distribution, the majority of them being genetically determined and mostly involving cardiomyopathy-causative genes (desmosomal but also other non-desmosomal related genes). Furthermore, inflammatory diseases, such as myocarditis or sarcoidosis, could be responsible for LV fibrosis, potentially exhibiting an RL distribution. Given the heterogeneity of such conditions, effective patient management requires a stepwise and multiparametric diagnostic work-up that integrates clinical, instrumental, and genetic data to identify the specific aetiology and guide personalised treatments.