Related Experiment Video
Updated: Oct 22, 2026
Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System
Published on: April 11, 2025
Late gadolinium enhancement dispersion mapping predicts major arrhythmic events in patients with prior myocardial
Roberto Licordari1, Giancarlo Todiere2, Carmelo De Gori2
1Department of Clinical and Experimental Medicine, University of Messina, Italy.
Background:
Myocardial scar heterogeneity is a key determinant of ventricular arrhythmias after myocardial infarction (MI). Late gadolinium enhancement dispersion mapping (LGE-DM) quantifies structural complexity, but its prognostic role in ischemic cardiomyopathy remains unevaluated.
Methods:
We retrospectively included 364 consecutive patients with prior MI (>90 days). For each LGE image, a parametric map was generated and each enhanced pixel scored (0-8) based on surrounding signal distribution; the global dispersion score (GDS) was calculated as the mean pixel score, quantifying pixel-to-pixel heterogeneity. The endpoint was a composite of sudden cardiac death (SCD), resuscitated cardiac arrest, sustained ventricular tachycardia, or appropriate ICD therapies.
Results:
During a median follow-up of 4 years, 42 arrhythmic events occurred. Patients with events showed significantly higher GDS than event-free patients (0.53 vs 0.32, P < 0.0001). Multivariable Cox regression confirmed GDS as an independent predictor (HR 1.16 per 0.1-unit increase, 95% CI 1.03-1.29), while LVEF and LGE extent were not, and GDS remained independently associated with events when LGE extent was forced into the model (HR 1.12 per 0.1-unit increase, P = 0.005). In patients with LVEF >35%, GDS was the only independent predictor across all multivariable models. Harrell's C-index was 0.682, with an optimism of 0.012 on bootstrap resampling. ROC analysis identified GDS >0.5 as a provisional cut-off derived within the same cohort (apparent AUC 0.74 overall; 0.81 in the LVEF >35% subgroup). Kaplan-Meier analysis confirmed worse prognosis in patients with GDS >0.5 (overall: p = 0.0002; LVEF >35%: p < 0.0001).
Conclusions:
LGE dispersion independently predicts malignant ventricular arrhythmias post-MI, outperforming LGE extent and LVEF. GDS may improve SCD risk stratification particularly in patients with LVEF >35%, a population not adequately targeted by current LVEF-based criteria. External validation is required before the proposed threshold can be used clinically.
