• Risk stratification for sudden cardiac death in non-ischemic cardiomyopathy remains challenging as left ventricular ejection fraction alone is an inadequate predictor of arrhythmic risk.
• The fibrosis entropy study utilised cardiovascular magnetic resonance to assess myocardial fibrosis and introduced fibrosis entropy, a novel metric quantifying the heterogeneity of scar tissue.
• Higher fibrosis entropy was independently associated with life-threatening ventricular arrhythmias and provided incremental prognostic value beyond conventional risk markers such as ejection fraction and overall scar burden.
• These findings suggest that scar heterogeneity may be an important determinant of arrhythmogenic risk and highlight the role of advanced CMR phenotyping to guide decision-making of device implantation in heart failure
Prevention of sudden cardiac death (SCD) remains one of the central challenges in contemporary heart failure management (1). In patients with non-ischemic cardiomyopathy (NICM), SCD accounts for up to one-third of all deaths after presentation (2). Current recommendations for primary prevention implantable cardioverter‑defibrillator (ICD) implantation have traditionally been guided primarily by left ventricular ejection fraction (LVEF), which is an imperfect surrogate for predicting SCD risk in NICM (3). Many patients with severe systolic dysfunction will never experience malignant ventricular arrhythmias (VA), while others with only modest reductions in LVEF may succumb to SCD (4).
The DANISH trial sough to address this uncertainty and despite its limitation, it demonstrated that ICD implantation in NICM significantly reduced SCD but failed to improve overall mortality in those receiving contemporary medical therapy (5). This emphasized the need for better arrhythmic risk stratification beyond LVEF alone (4).
Author Heartbeat Sub-Editor: Dr Khin Kay Kay Kyaw I am currently working as cardiology specialist registrar ST6 at southwest peninsula region while also working as
Author Sub-editor: Dr Pok-Tin Tang Dr Pok-Tin Tang is an ST5 cardiology registrar in the Thames Valley deanery, currently undertaking a period of out of
Author Sub-editor: Dr May Hu Dr May Hu is a cardiology trainee in the North West deanery. She graduated with First Class Honours from the University
Author Sub-editor: Dr Jhiamluka Solano Dr Jhiamluka Solano is a cardiology resident doctor (ST6) in the Yorkshire and Humber Deanery, currently undertaking a DPhil (PhD)
Author Sub-editor: Dr Joshua Rowland Dr Joshua Rowland is a cardiology registrar working in the North West Deanery. He graduated from the University of Manchester
