In hypertrophic cardiomyopathy (HCM), late gadolinium enhancement (LGE) extent >= 15% of left ventricular mass is considered a prognostic risk factor. LGE extent increases over time and the clinical role of the progression of LGE over time (LGE rate) was not prospectively evaluated. We sought to evaluate the prognostic role of the LGE rate in HCM. We enrolled 105 patients with HCM who underwent cardiac magnetic resonance (CMR) at baseline (CMR-I) and after >= 2 years of follow-up (CMR-II). LGE rate was defined as the ratio between the increase of LGE extent (grams) and the time interval (months) between examinations. A combined end point of sudden cardiac death, resuscitated cardiac arrest, appropriate Implanted Cardioverter Defibrillator (ICD) intervention, and sustained ventricular tachycardia was used (hard events). The percentage of patients with LGE extent >= 15% increased from 9% to 20% from CMR-I to CMR-II (p = 0.03). During a median follow-up of 52 months, 25 hard events were recorded. The presence of LGE >= 15% at CMR-II allowed a significant reclassification of the risk of patients than at LGE >= 15% at CMR-I (net reclassification improvement 0.21, p = 0.046). On the MaxStat analysis, the optimal prognostic cut point for LGE rate was >0.07 g/ month. On the Kaplan-Meier curve, patients with LGE rate >0.07 had worse prognosis than those without (p <0.0001). LGE rate >0.07 allowed a significant reclassification of the risk compared with LGE >= 15% at CMR-I and at CMR-II (net reclassification improvement 0.49, p = 0.003). In the multivariable models, LGE rate >0.07 was the best independent predictor of hard events. In conclusion, CMR should be repeated after 2 years to reclassify the risk for sudden death of those patients. A high LGE rate may be considered a novel prognostic factor in HCM.(c) 2023 Elsevier Inc. All rights reserved.

Abstract Background Catheter ablation is a cornerstone treatment for scar-related ventricular arrhythmias arising in patients affected by structural heart disease. Imaging integration with electroanatomical mapping (EAM) suites for ventricular tachycardia (VT) ablation procedural guidance is an established step for advanced substrate characterization and treatment. Purpose To compare and validate different approaches for intraprocedural multisource imaging registration and integration with EAM suites for VT ablation guidance. Methods Thirty consecutive patients prospectively enrolled in the ongoing VOYAGE clinical trial for imaging guided/aided VT ablation at our center were retrospectively analyzed. Multidetector computed tomography (MDCT) and late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging was performed before procedure. MDCT and LGE-CMR images were both acquired during end-expiratory breath hold. Same cardiac cycle phase images were used. Wide band LGE-CMR was acquired in case of a cardiac implantable electronic device was present to reduce artifacts. Images were imported in ADAS3D software. MDCT and CMR images were manually registered using established anatomical landmarks (left ventricle outflow tract, left ventricle apex, papillary muscles, left and right ventricle junction), were then respectively processed for aortic/ventricular anatomical reconstruction and myocardial characterization and then imported in CARTO3 electroanatomical mapping suite for procedural guidance. Registration between EAM and imaging was either performed with ascending aorta fast anatomical mapping (FAM) and 3D landmark alignment with aortic MDCT or via intracardiac echocardiography (ICE) left ventricle (LV) chamber segmentation and 3D landmark alignment with ventricular MDCT. ICE segmentation was also obtained for every case regardless of aortic FAM. Surface match between ICE and MDCT LV chamber reconstructions was calculated for method comparison. Results All 30 patients had an ICE segmentation of the LV, with a mean of 15,66±4,89 contours. Aortic FAM was obtained and used for aortic MDCT registration in 10 subjects. LV ICE was instead used for imaging alignment in 20 subjects. When compared to aortic FAM, LV ICE to LV MDCT alignment achieved lower average surface distance (3,86±1,41 mm vs 8,884±6,77 mm; p<0,001), lower minimum surface distance (0,002±0,03 vs 0,07±0,06; p= 0,001) and lower maximum surface distance (14,16±4,37 vs 22,93±11,10; p<0,001). Conclusion An optimized workflow consisting of ICE LV chamber segmentation was superior in terms of 3D surface distance to aortic FAM reconstruction to obtain reliable multisource imaging registration for MDCT/CMR guided/aided VT ablation.

The sensing of left ventricular (LV) activity is fundamental in the diagnosis and monitoring of cardiovascular health in high-risk patients after cardiac surgery to achieve better short- and long-term outcome. Conventional approaches rely on noninvasive measurements even if, in the latest years, invasive microelectromechanical systems (MEMS) sensors have emerged as a valuable approach for precise and continuous monitoring of cardiac activity. The main challenges in designing cardiac MEMS sensors are represented by miniaturization, biocompatibility, and long-term stability. Here, we present a MEMS piezoresistive cardiac sensor capable of continuous monitoring of LV activity over time following epicardial implantation with a pericardial patch graft in adult minipigs. In acute and chronic scenarios, the sensor was able to compute heart rate with a root mean square error lower than 2 BPM. Early after up to 1 month of implantation, the device was able to record the heart activity during the most important phases of the cardiac cycle (systole and diastole peaks). The sensor signal waveform, in addition, closely reflected the typical waveforms of pressure signal obtained via intraventricular catheters, offering a safer alternative to heart catheterization. Furthermore, histological analysis of the LV implantation site following sensor retrieval revealed no evidence of myocardial fibrosis. Our results suggest that the epicardial LV implantation of an MEMS sensor is a suitable and reliable approach for direct continuous monitoring of cardiac activity. This work envisions the use of this sensor as a cardiac sensing device in closed-loop applications for patients undergoing heart surgery.

Abstract Background An intense inflammatory and fibrotic response after myocardial infarction (MI) may lead to scar expansion and left ventricular (LV) remodeling, increasing the risk for ventricular arrhythmias and heart failure. Colchicine is an anti-inflammatory drug that has been reported to improve the outcome of patients with MI; its effects on LV remodeling have not been specifically investigated. We aimed to characterize the effects of the anti-inflammatory drug colchicine in an animal model of reperfused MI. Methods In 4-month-old pigs, MI was induced by occluding the LAD artery through an angioplasty balloon for 90 minutes. Pigs surviving MI induction were randomized in a 1:1 fashion to 2 arms: - control group (n=13): MI induction and reperfusion, standard treatment (the same therapies as in the rat study), - colchicine group (n=13): MI induction and reperfusion, standard treatment plus colchicine. The pigs underwent a first CMR scan 72 hours after MI induction, and another CMR at day 30. The pigs were then sacrificed the day after the second CMR. The primary efficacy endpoint was LGE mass (as a percentage of LV mass). Results The infarcted area at 72 hours (expressed as absolute mass or as a percentage of the LV mass) and the changes over 1 month did not differ significantly between pigs on colchicine plus standard therapy vs. those on standard therapy alone. When assessing the extent of fibrosis on the explanted hearts (as a percentage of the tissue sample areas) there was a trend toward a lower extent of myocardial fibrosis in pigs on colchicine plus standard therapy (p=0.091). The percent differences in LV volumes, ejection fraction and mass across the two CMR scans did not reach statistical difference. Conclusions The results from a pig model of reperfused MI suggest that colchicine has no additional effects to standard MI therapy on MI size and LV remodeling.

Abstract Background COVID-19 infection can lead to a constellation of long-lasting post-infectious sequelae, including myocardial dysfunction, whose outcome is strongly affected by a fine-tuned balance between pro- and anti-inflammatory systemic immune responses. Plasma cytokines are key mediators of this immunological balance. In this preliminary study we evaluated the cross-sectional association between the circulating levels of the main pro- and anti-inflammatory cytokines and cardiac magnetic resonance (CMR) abnormalities. Methods 71 subjects (59% female, mean age 52±14) with previous diagnosis of COVID-19 infection were enrolled at our institution for MULTICOVID protocol, comprehensive of CMR and biomarkers assessment performed >3 months and <1 year following the first negative swab test. CMR protocols consisted of conventional sequences (cine, T2-weighted imaging, and late gadolinium enhancement [LGE]) and quantitative mapping sequences (T1, T2, and extracellular volume [ECV] mapping). Plasma levels of cytokines TNF-α, IL-1β, IL-1α, IFN-α2, IL-6, IL-8, IL-13, IL-10, IL-17A, IL-18, IP-10, MIG and MCP-1 were quantified by Multiplex Immunoassays on the Luminex technology platform. Soluble cardiologic and biochemical biomarkers were measured by routine laboratory analysis. Results After a median of 9 (IQR 6–11) months following negative swab, CMR was normal in 48 subjects, while in 23 (32%) it revealed tissue characterization abnormalities (myocardial late enhancement and/or edema). By multivariate regression analysis (adjusted for age, sex, vaccination, severity degrees of the initial COVID disease, presence of comorbidities, smoke, time interval between COVID diagnosis and CMR assessment) the cytokine ratio TNF-α/(IL-10+IL-13) was independently associated (OR=2.89, 95% CI 1.19–7.04, p=0.02) with CMR abnormalities. Interestingly, the cumulative pro-/anti-inflammatory cytokine ratio (IL-1β+TNF-α+IFN-α2+IL-6+IL-17A+IL-8)/(IL-10+IL-13) showed a positive (OR=1.70, 95% CI: 1.04–2.75) and significant (p=0.03) association with CMR imaging aspects. Also, the ratio IFN-α2/(IL-10+IL-13), although without achieving a complete statistical significance (p=0.09), was associated positively with CMR findings. Conclusions The preliminary results of this cross-sectional study suggest that the systemic inflammatory environment, long-lasting unbalanced towards a prevalent cytokine-driven pro-inflammatory condition following COVID infection, could affect the development of CMR-detectable myocardial edema and fibrosis in long-term post-COVID subjects. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Tuscany Region

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Mitral vAlve prolapse and disjunction by cardiac maGnetIC resonance (MA-GIC) registry Backgroung Mitral valve prolapse (MVP) is 2-3% prevalent in the general population with good prognosis. However, some patients develop complex ventricular arrhythmias (CVAs), sudden cardiac death (SCD), or severe mitral regurgitation (MR). Previous studies suggested that bi-leaflet involvement, mitral annulus disjunction (MAD), and myocardial fibrosis (MF) are associated with adverse outcome. Notwithstanding, these findings were limited to autopsic series or single-centre studies involving highly selected patients. Moreover, MF has been scantly investigated as predictor of clinical outcome. Purpose To investigate the prognostic significance of MF in an international multicentre study of MVP patients studied by cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE). Methods From October 2007 to June 2020 patients undergoing LGE-CMR were screened in 14 European centres. Inclusion criteria were: i) age > 18 years; ii) full clinical history and cardiac rhythm monitoring at baseline; iii) MVP (leaflet displacement ≥ 2 mm beyond the annulus). Exclusion criteria were: i) ischemic heart disease; ii) primary cardiomyopathy; iii) inflammatory heart disease; iv) congenital heart diseases; v) moderate-to-severe valvular heart disease. CVAs at the study outset was defined as one of the following: i) ventricular ectopic beats >10000/24h; ii) ≥ 1 episode of non-sustained ventricular tachycardia (VT); iii) sustained VT; iv) aborted SCD. Primary end-point was a composite of SCD, unexplained syncope, and mitral valve repair/replacement. Secondary end-point was a composite of SCD and unexplained syncope. Results Four-hundred-fifty-eight MVP patients were eventually included (46 ± 16 years old, 51% males) of whom 68% had MAD. LGE was detected in 103 (22%) of subjects with mid-wall pattern (46%) in left ventricular (LV) lateral wall (66%) as the most prevalent feature. At baseline, 37% of LGE-positive patients vs. 18% of LGE-negative individuals had CVAs (P < 0.001). SVT and/or aborted SCD were more prevalent in LGE-positive than in LGE-negative patients (9% vs 2%, P < 0.001). By multivariable Cox-regression analysis, LGE presence or extent were strong independent predictors of the primary (HR = 4.02, P = 0.003 and HR = 4.76 per 10% increase, P = 0.032, respectively) and secondary (HR = 5.39, P = 0.008 and HR = 8.78 per 10% increase, P = 0.012, respectively) endpoints after correction for major confounders including LV volumes, left atrial size and MAD presence. Conlusion Myocardial fibrosis by LGE is the strongest independent predictor of clinical outcome in MVP. In contrast, MAD per se does not harbinger worse prognosis.

Background and Aims: Lecithin Cholesterol Acyltransferase (LCAT) deficiency is a rare autosomal recessive genetic defect leading to two different clinical phenotypes: Familial LCAT Deficiency and Fish Eye Disease.

Left ventricular hypertrophy (LVH) may be due to different causes, ranging from, benign secondary forms (athlete's heart) to severe prognosis cardiomyopathies (i.e. cardiac amyloidosis). Early and accurate differential diagnosis is important to proper patient management. LVH may be detected by echocardiography signs of hypertrophy or other abnormalities often associated to hypertrophic phenotypes. Cardiac magnetic resonance (CMR) is often used to confirm the initial diagnostic suspicion. On the best of our knowledge, there are no study specifically designed to evaluate the final impact of CMR in changing or confirming the initial diagnostic echocardiographic suspicion. To evaluate the clinical prognostic correlates of CMR in patients with echocardiographic or ECG suspicion of LVH (or cardiomyopathies with hypertrophic phenotype). We enrolled 275 pts with echocardiographic evidence of LVH. Using current guidelines, the initial echocardiographic diagnostic suspicion was: hypertrophic cardiomyopathy (HCM) in 46.9% of pts; cardiac amyloidosis in 14.5%; hypertensive LVH in 17%; aortic stenosis in 1.5%; athlete's heart in 0.3%; undetermined LVH in 17%. CMR changed the diagnosis in 42% cases: the diagnosis of HCM increased from 44% to 72% of pts; hypertensive and undetermined LVH decreased significantly (respectively to 4% and 5%). Finally, the change in diagnostic suspicion was associated to reclassification of risk of patients: Kaplan-Meier curves demonstrated that HCM and cardiac amyloidosis had worst prognosis than undetermined or hypertensive LVH. CMR changed the echocardiographic suspicion in almost half of patients with LVH. This study highlights the indication of CMR in patient with ECG or echocardiographic suspicion of LVH. Kaplan-Meier curves Type of funding source: None

BACKGROUND: Sudden cardiac death (SCD) is the most dramatic complication of hypertrophic cardiomyopathy (HCM).ESC Guidelines suggest the implantation of a defibrillator in primary prevention according to a 5-year Risk SCD score ≥ 6%.When the 5-years Risk SCD score is intermediate (≥4-<6%) there is not a clear recommendation for ICD implantation, and many sudden cardiac deaths occurs also in patients with lower risk. PURPOSE:The aim of the study is to evaluate the prognostic role of late gadolinium enhancement (LGE) in patients with a 5-year Risk SCD score <6%. METHODS:This study was multicenter investigation.We enrolled 354 consecutive patients (257 males, range of age 54+-17) with a risk SCD score <6%.CMR examination was performed using 1.5 Tesla systems in entire population.LGE extent was measured by a previously validated method.After the CMR examination, a follow-up was performed for all patients administering a clinical questionnaire for hard cardiac events including SCD, resuscitated cardiac arrest, appropriate ICD shock, anti-tachycardia pacing, and sustained ventricular tachycardia. RESULTS:Hard cardiac events occurred in 22 patients.230 (65%) patients were positive for LGE at visual assessment.LGE was detected in a high proportion (92%) of patients who experienced of hard cardiac events.The worst prognosis was found in subjects with extreme LV hypertrophy (p = 0.04), higher LV mass (p = 0.034) and extent of LGE (p = 0.002).LGE extent was the best independent predictor of hard cardiac events (HR 1.05; 95% CI 1.03-107; p < 0,0001) and at Kaplan-Meier curves patients with LGE≥10% had a worst prognosis than those with lower extent (p< 0.0001).CONCLUSION: This is the first study that demonstrates as the extent of LGE≥10% is able to recognize additional patients at increased risk for malignant arrhythmic episodes in a population with low-intermediate ESC SCD risk score.

Abstract Background Implantable cardioverter defibrillator (ICD) is recommended for patients with non-ischaemic heart failure (HF) and left ventricular ejection fraction (LVEF) ≤35%, although most patients will not experience any appropriate ICD intervention. We assessed if cardiovascular magnetic resonance (CMR) findings may predict benefit from ICD implantation. Methods and results We retrieved the data of all patients (n=183) with non-ischaemic HF receiving an ICD for primary prevention at our Institution, and undergoing CMR within 1 month before implantation. 183 patients were evaluated (men 73%, median age 66 years, LVEF 24%, N-terminal fraction of pro-B-type natriuretic peptide 1217 ng/L, atrial fibrillation, flutter or atrial ectopic rhythm 21%). They received single-chamber (n=21, 12%), dual-chamber (n=34, 19%), or cardiac resynchronization therapy devices (n=127, 69%); 1 patient (1%) received a subcutaneous defibrillator. Twenty patients (11%) experienced a shock for ventricular tachycardia or fibrillation (VT/VF) over 2.5 years (0.8–5.4), and 13 (7%) had an inappropriate shock over 2.7 years (0.9–5.4). Late gadolinium enhancement (LGE) was present in 146 patients (80%), but on average accounted for limited percentage of LV mass (4% [2–11%]). LGE mass independently predicted shocks for VT/VF (HR 2.13, 95% CI 1.02–4.47; p=0.045). LGE mass ≥14% (the best cut-off at receiver operating characteristics analysis) independently predicted shocks for VT/VF (HR 3.82, 95% CI 1.51–9.68; p=0.005). LGE mass <4% was the only univariate predictor of inappropriate shocks (HR 4.82, 95% CI 1.07–21.76; p=0.041). Conclusions Patients with non-ischaemic HF and LGE mass ≥14% benefit most from ICD, while those with LGE mass <4% display mainly inappropriate shocks.

Abstract Background Left atrial function (AEF) is a parameter of paramount importance that has a prognostic value in a number of heart conditions. Cardiac involvement in both light-chain and transthyretin amyloidosis is the main driver of prognosis and influences treatment strategies. Cardiac magnetic resonance (CMR) provides high quality images of the left and right atria using high temporal resolution steady state free precession (SSFP) cine sequences. Purpose The aim of our study was to assess by CMR left atrial function and his correlation with prognosis in patients with cardiac amyloidosis. Method We enrolled 80 consecutive patients with diagnosis of cardiac amyloidosis: 38 patients (47%) with light-chain and 42 patients (53%) with transthyretin one. CMR was performed using a 1.5-T scanner. In all subjects, the study of atria was obtained by acquiring cine steady-state free precession (SSFP). Left Atrial function was evaluated by the ratio between the maximum and the minimum LA volume. A median follow up of 937 days was performed and 36 patients (44%) died of cardiac causes. We evaluated cardiac death as endpoint. We split out all the patient in 4 different quartiles depending on left atrial function: in the first quartile patients with AEF≤14% that reflects severe atrial dysfunction, in the second quartile patients with AEF between 14 and 19%, in the third quartile patients with AEF between 19 and 36% and in the last one patients with AEF≥36% that represent patients with normal value of left atrial function. Results We found that CMR assessed left atrial function allowed to individuate and stratify the prognosis in patients with cardiac amyloidosis. The most effective parameter to evaluate cardiac death was left atrial function with a cut off ≤14% that could predict cardiac related mortality with the same accuracy in both light-chain and transthyretin amyloidosis patients. Kaplan Meier analysis showed that patients with AEF≤14% had a worse prognosis as compared to patient with AEF≥14% (log rank p. 0001). Furthermore patients with AEF≤14% have a cardiac death risk of 32% at 1 year and 61% at 3 years. Kaplan Meier analysis Conclusion Cardiac magnetic resonance is an imaging modality that allows to individuate with great accuracy left atrial function in patients with various heart conditions and especially cardiac amyloidosis. CMR left atrial function assessment clearly identifies a subgroup of cardiac amyloid patients with an increased risk of death.

Background:In ST-segment-elevation myocardial infarction (STEMI), cardiovascular magnetic resonance (CMR) holds the potentiality to improve risk stratification beyond Thrombolysis-in-Myocardial-Infarction (TIMI) risk-score.Nevertheless, the optimal timing for CMR after STEMI remains poorly defined.Objectives: Comparing prognostic performance of three different stratification strategies according to the timing of CMR after STEMI.Methods: The population of this prospective registry-based study included 511 reperfused STEMI patients.All patients underwent post-reperfusion (median:4-days post-STEMI) and follow-up (median:4.8-monthspost-STEMI) CMR.Left ventricular (LV) volumes, function, infarct-size and microvascular-obstruction extent (MVO) were quantified.Primary end-point was a composite of all-death and heart failure (HF) hospitalization.Three multivariate models were developed including TIMI risk-score plus early post-STEMI (early-CMR) or follow-up CMR (deferred-CMR) or both CMRs parameters along with adverse LV remodeling (paired-CMRs).Results: During a median follow-up of 8.5 years, primary end-point occurred in 85 patients (23 deaths; 38 HF hospitalization).Early-CMR, deferred-CMR and paired-CMRs demonstrated similar predictive value for primary end-point (C-statistic: 0.726, 0.728, 0.738, respectively; P = 0.663).However, early-CMR enabled to correctly estimate poor outcome in 4 of 7 patients (56%) developing primary end-point between early-and deferred-CMR.Conclusions: In STEMI, early-CMR should be considered the preferred strategy for timely effective risk stratification.

Abstract Background In patients with non-ischaemic systolic heart failure (HF) and left bundle branch block (LBBB), the systolic phase of the left ventricular (LV) volume/time (V/t) curve at cardiac magnetic resonance (CMR) can display a wide or a narrow pattern (WP/NP). The clinical and prognostic significance of these patterns are currently unknown. Methods Consecutive patients with systolic non-ischaemic HF (LV ejection fraction <50%) and LBBB were enrolled. They underwent a baseline evaluation including CMR, and were periodically re-evaluated during follow-up. The endpoint was a composite of cardiovascular death, heart failure (HF)-related event, and ventricular arrhythmias requiring defibrillator shock. Results Out of 101 patients (mean age 64±11 years, males 50%), NP was found in 29 and WP in 72, with no difference in QRS duration. Patients with WP had worse clinical presentation and greater LV volumes, but similar LGE prevalence, extent or distribution. The WP subgroup displayed a greater maximal dyssynchrony time, expressed both as absolute duration (192±80 vs. 143±65 ms, P<0.001), and as percentage of the RR interval (25±11% vs. 8±4%, p<0.001). Even the systolic dyssynchrony index was higher in patients with WP (13±4 vs. 7±3%, p<0.001). The contractility index was lower in patients with the WP (2.6±1.2 vs 3.2±1.7, p<0.05). Over a median follow-up duration of 44 months (interquartile interval 23–59), only WP (p=0.029) and NT-proBNP (p=0.004) demonstrated an independent prognostic value for cardiac events. Conclusions In patients with non-ischaemic systolic HF and LBBB, the WP of V/t curves identifies a subgroup of patients with greater LV dyssynchrony, worse clinical conditions and prognosis.

Introduction.In nonischaemic dilated cardiomyopathy (DCM), primary prevention with an implantable cardioverter defibrillator (ICD) is currently recommended for patients with left ventricular ejection fraction (LVEF) ≤35% despite optimal medical therapy.No solid evidence exists to support this recommendation: most patients will not experience any appropriate ICD intervention, and better patient selection is needed.Purpose.In DCM patients receiving an ICD for primary prevention, we investigated whether pre-implant cardiovascular magnetic resonance (CMR) could predict an appropriate intervention during follow-up.Methods.We included 194 patients (age 63 ± 12 years, 143 male), with a LVEF ≤35% despite at least three months of optimal medical therapy, who underwent clinical, electrocardiographic, echocardiographic, biohumoral and CMR assessment, before ICD implantation for primary prevention.Myocardial fibrosis was quantified using late gadolinium enhancement (LGE) as percentage of left ventricular (LV) myocardial mass.All patients received guideline-recommended therapy during follow-up.The endpoints were cardiac death and appropriate ICD shocks.Results.During follow-up (median 40 months [interquartile range 13-71]), there were 21 appropriate shocks.Among all CMR parameters, the only univariate predictors of appropriate ICD discharge were LVEF (hazard ratio -HR 1.05, 95% confidence interval -CI 1.01-1.09;p = 0.03) and LGE extent (ln-transformed values: hazard ratio -HR 2.01, 95% confidence interval -CI 1.29-3.15;p = 0.002); at multivariate analysis, LGE extent remained a significant predictor of appropriate ICD shocks independently from other clinical, biohumoral and imaging parameters.At ROC analysis, LGE predicted appropriate ICD shocks (AUC = 0.69, p = 0.04) with the best cut-off ≥11% (62% sensitivity, 78% specificity).Patients with LGE ≥11% had a 6-fold higher risk of appropriate ICD discharge (relative risk 6.06, 95% CI 2.50-14.69),and a shorter survival free from discharge (at Kaplan-Meier analysis, p < 0.001, Figure 1).On the other hand, during follow-up there were 14 cardiac deaths, all due to heart failure, and LGE did not predict cardiac death (p = NS). Conclusions.In DCM patients undergoing ICD implantation for primary prevention, LGE mass (with the best cut-off ≥11%) is an independent predictor of the occurrence of life-threatening arrhythmias requiring defibrillator discharge.