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      Muser et al (Circulation January 6, 2021;https://doi.org/10.1161/CIRCULATIONAHA.120.047640, PMID 33401956) investigated the prognostic significance of a specific left ventricular late gadolinium (LV-LGE) phenotype characterized by a ring-like pattern of fibrosis. A ring-like pattern of LV scar was defined as LV subepicardial/midmyocardial LGE involving at least 3 contiguous segments in the same short-axis slice. The end point of the study was time to the composite outcome of all-cause death, resuscitated cardiac arrest due to ventricular fibrillation or hemodynamically unstable ventricular tachycardia, and appropriate implantable cardioverter-defibrillator therapy. Of the 686 patients with idiopathic nonsustained ventricular arrhythmias, 28 patients (4%) had a ring-like pattern of scar (group A), 78 (11%) a non–ring-like pattern (group B), and 580 (85%) had normal cardiac magnetic resonance with no LGE (group C). At follow-up of 61 months, the composite outcome occurred in 14 patients (50%) in group A vs 15 (19%) in group B and 2 (0.3%) in group C (P < .01). LGE with a ring-like pattern remained independently associated with increased risk of the composite end point (hazard ratio 68.98; P < .01). The authors conclude that in patients with apparently idiopathic nonsustained VA, nonischemic LV scar with a ring-like pattern is associated with malignant arrhythmic events.
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