# Cardiac Magnetic Resonance and Ventricular Arrhythmia Risk Assessment in Chronic Ischemic Cardiomyopathy: An Unmet Need?

## TL;DR

This paper discusses how cardiac magnetic resonance imaging can improve risk assessment for arrhythmias in heart disease patients beyond traditional measures like ejection fraction.

## Contribution

Highlights the potential of CMR-LGE to better assess arrhythmia risk compared to LVEF alone in ischemic cardiomyopathy.

## Key findings

- LVEF has limited sensitivity and specificity for predicting sudden cardiac death in ICM.
- CMR-LGE provides valuable insights into myocardial fibrosis linked to arrhythmias and sudden cardiac death.
- Current clinical guidelines may over-rely on LVEF for ICD placement decisions.

## Abstract

Ischemic cardiomyopathy (ICM) constitutes a major public health issue, directly
involved in the prevalence and incidence of heart failure, ventricular
arrhythmias (VA) and sudden cardiac death (SCD). Severe impairment of left
ventricular ejection fraction (LVEF) is considered a high-risk marker for SCD,
conditioning the criteria that determine an implantable cardiac defibrillator (ICD)
placement in primary prevention according to current clinical guidelines.
However, its sensitivity and specificity values for the prediction of SCD in ICM
may not be highest. Myocardial characterization using cardiac magnetic resonance
with late gadolinium enhancement (CMR-LGE) sequences has made it possible to
answer clinically relevant questions that are currently not assessable with LVEF
alone. There is growing scientific evidence in favor of the relationship between
fibrosis evaluated with CMR and the appearance of VA/SCD in patients with ICM.
This evidence should make us contemplate a more realistic clinical value of LVEF
in our daily clinical decision-making.