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Background: Accurate risk stratification for patients with non-dilated left ventricular cardiomyopathy (NDLVC) remains challenging due to lack of dedicated clinical trials. This post-hoc analysis aims to delineate the arrhythmic risk and assess the incremental value of cardiac magnetic resonance (CMR) imaging in the DERIVATE (CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DebrillAtor ThErapy) study cohort meeting the NDLVC diagnostic criteria., Methods: Patients with NDLVC from DERIVATE registry were identified in the absence of left ventricular (LV) dilatation and in the presence of non-ischaemic LV scarring ("fibrotic NDLVC") or isolated LV systolic dysfunction (LV ejection fraction <50%) without fibrosis ("hypokinetic NDLVC"). The primary endpoint was all-cause mortality. Major adverse arrhythmic cardiac events (MAACE) were the secondary endpoint and included sudden cardiac death (SCD) and aborted SCD., Results: One hundred ninety-seven NDLVC patients were identified from the cohort of the DERIVATE study (Mean age: 59±14 years; Male: 135). Over a median follow-up of 2.7 years, 15 (8%) patients died, and 8 (4%) experienced MAACE. Patients with "hypokinetic" NDLVC had significantly lower rates of MAACE than non-ischaemic dilated cardiomyopathy (NIDCM) (p=0.001), while patients with "fibrotic" NDLVC had same rate of both primary (p=0.48) and secondary endpoints (p= 0.616) compared to NIDMC patients. Multivariable analysis identified LGE with midwall distribution as an independent predictor of MAACE in NDLVC patients (Hazard Ratio 6.7, 95% Confidence Interval: 1.33-33.67; p=0.021)., Conclusions: NDLVC patients exhibit a heterogeneous risk profile for arrhythmic events. The presence of midwall LGE, similarly to NIDCM, is a significant predictor of MAACE, highlighting the importance of CMR imaging for risk stratification., (© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Imaging plays an integral role in all aspects of managing heart disease and cardiac imaging is a core competency of cardiologists. The adequate delivery of cardiac imaging services requires expertise in both imaging methodology-with specific adaptations to imaging of the heart-as well as intricate knowledge of heart disease. The European Society of Cardiology (ESC) and the European Association of Cardiovascular Imaging have developed and implemented a successful education and certification programme for all cardiac imaging modalities. This programme equips cardiologists to provide high quality competency-based cardiac imaging services ensuring they are adequately trained and competent in the entire process of cardiac imaging, from the clinical indication via selecting the best imaging test to answer the clinical question, to image acquisition, analysis, interpretation, storage, repository, and results dissemination. This statement emphasizes the need for competency-based cardiac imaging delivery which is key to optimal, effective and efficient, patient care., Competing Interests: Conflict of interest: M.W. is the director and cofounder of MyocardiumAI and declares stock or stock options for the provision of core lab services in cardiac MRI. MyocardiumAI has partially funded Mark Westwood for support for attendings meetings and/or travel [Society for Cardiovascular Magnetic Resonance (SCMR)] and [American College of Cardiology (ACC) Annual Meeting]. E.B. declares consulting fees from Microport and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Abbott, Boston Scientific, and Insight Lifetech. V.D. declares payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Novo Nordisk (heart failure), Edwards Lifesciences (tricuspid valve). S.D. reports being the Chair of the Cardiac Magnetic Resonance Working Group of the Italian Society of Cardiology. L.G. declares personal consulting fees from Caption Health and personal payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from EchoNous, Philips Healthcare, GE Healthcare. P.M.-H. declares shares from Neumann Medical Ltd. J.L.M. declares grants or contracts through his institution from Abbott and Medtronic; personal consulting fees from Medtronic and Sanofi; personal payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Biotronik, Microport, Milestone Pharmaceutical, and Zoll. R.M. declares payment for expert testimony through the British charity CardiomyopathyUK; no payments (hotel, flights, meals) for attending meetings and/or travel from the ESC (Patient representative) and More-EUROPA (Horizon funded, HORIZON-HLTH-2022-TOOL-11-02) (Patient on Advisory Board). L.N. reports grants or contracts through her institution from Daiichi Sankyo; under 1000 USD personal honoraria from Pfizer-BMS. R.N. reports an unrestricted research grant from Philips Volcano and Biotronik, one-time personal consulting fee from Sanofi Genzyme; a speakers fee from Sanofi Genzyme and BMS; being Vice-Chair of EACVI (CMR Section Chair). M.P. reports research grants through his institution from the charity ‘Cardiac Risk in the Young’; 5000 GBP consulting fees from Bristol Myers Squibb; being the president of the EAPC and being a Board member of the ESC. G.P. reports grants or contracts from GE Healthcare, Bracco, Heartflow; consulting fees from GE Healthcare, Heartflow; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from GE Healthcare, Heartflow; support for attending meetings and/or travel from GE Healthcare, Heartflow. S.P. is a volunteer for the ESC Board (member); for the European Heart Journal (deputy editor); and the ESC Education Committee (Chair). G.M.C.R. declares grants or contracts from the Ricerca Finalizzata Ministero della Salute, Italy; supports for attending meetings and/or travel from Menarini, AstraZeneca, Bayer, Servier, Vifor; being the president of the HFA. A.R. declares being a member of the Task Force ESC-Fleischner Society for pulmonary embolism, of the Working Group EuroHeart Outcome Data Standards development; of the 2022–24 EACVI: Councillor of Nuclear and Cardiac CT Section, Deputy chair of the ‘Certification Cardiac CT Sub-committee’, Deputy chair of the ‘Research & Innovation Committee’; Member of the ‘Scientific Documents Committee’, of the 2022–24 Committee of the Società Italiana di Ecocardiografia e Imaging Cardiovascolare: ‘Imaging cardiovascolare integrato complesso.’ J.S.-M. is the Deputy Chair, EACVI Industry Round Table Committee and past president of SCMR, CAB SCMR. S.E.P. declares consulting fees from Circle Cardiovascular Imaging, Inc., Calgary, Canada; Support for attending meetings and/or travel from the ESC; is the president of EACVI, an ESC Board member, a member of the Advocacy Committee of the Society for Cardiovascular Magnetic Resonance: Member. A.G.A., K.F.F., K.H., D.M., L.E.S., F.W., and S.A. declares no conflict of interest for this contribution., (This article has been co-published with permission in the European Heart Journal, European Heart Journal – Cardiovascular Imaging, and European Heart Journal – Imaging Methods and Practice. © 2023 the European Society of Cardiology The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article.)

In patients with suspected or established hypertrophic cardiomyopathy (HCM), cardiovascular magnetic resonance (CMR) is widely employed for clinical management, given its multimodality approach capable of providing unique information on cardiac morphology, function, and tissue characterization. Guidance regarding all aspects of HCM diagnosis and management is provided by the comprehensive 2014 European Society of Cardiology (ESC) guidelines on HCM. CMR should be performed in centres with recognized expertise in heart muscle diseases, by physicians who are familiar with the whole HCM disease spectrum, differential diagnoses, and pitfalls. Because CMR is usually performed and interpreted by physicians not directly involved in patient care, detailed, bidirectional, and standardized communication becomes essential to obtain best results and avoid misinterpretation. In order to maximize the potential of CMR, it is of paramount importance that reporting physicians are provided with the essential clinical information and that, in turn, referring physicians are given a core set of CMR morphological, functional, and tissue characterization results following the test. This article aims to summarize the current knowledge on the role of CMR in managing HCM and, in addition, to review the importance of the clinical context in which the report is provided, in both adult and paediatric population, highlighting implications for clinical research.

Aims: The aim of the present study was to assess the association of the presence and amount of late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) with cardiovascular adverse events in patients with orthotopic heart transplantation (HTx)., Methods and Results: We enrolled 48 patients (mean age, 54.7 ± 14.6 years; 37 men) at various stages after HTx. All patients underwent standard CMR at 1.5 T, to characterize both cardiac anatomy and LGE. Late gadolinium enhancement was detected in 26 patients (54%). All-cause and cardiovascular mortalities, and a composite of major adverse cardiovascular events (MACE) recurrence were evaluated during the follow-up period for a median of 5.16 years. Ten patients (21%) died and 26 (54%) were readmitted because of MACE. Multivariate Cox analysis identified as independent predictors of MACE a diagnosis of cardiac allograft vasculopathy (CAV) (HR 3.63; 1.5-8.7 95% CI; P = 0.0039), left ventricular end systolic volume index (HR 1.04; 95% CI 1.01-1.079; P = 0.008), LGE mass (HR 1.04; 1.01-1.06 95% CI; P = 0.0007), LGE % of left ventricular mass (HR 1.083; 1.03-1.13 95% CI; P = 0.0002). Independent predictors of all-cause death were CAV (HR 6.33; 95% CI 1.33-30.03; P = 0.0201), LGE mass (HR 1.04; 1.01-1.07 95% CI; P = 0.005), LGE % of left ventricular mass (HR 1.075; 1.02-1.13 95% CI; P = 0.007). Patients with CAV had a risk of MACE by 5 years of 67% (95% CI 0.309-0.851%); the addition of 7.9 LGE % to the risk model increased the predicted risk to 88% (95% CI 0.572-0.967%)., Conclusions: The current study demonstrated that the presence of CAV and the total amount of LGE have a significant independent association with MACE and mortality in HTx patients., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.)

Coronary artery disease (CAD) is the major cause of morbidity and mortality worldwide. More than 50% of CAD deaths occur in previously asymptomatic individuals at intermediate cardiovascular risk, highlighting the need of more accurate individual risk assessment to decrease cardiovascular events. Cardiac computed tomography (CCT) has emerged as a valuable technique for risk stratification in asymptomatic subjects and in symptomatic patients without known CAD. The absence of coronary artery calcium (CAC) identifies asymptomatic subjects at very low cardiac risk and is reasonable in intermediate risk individuals, in whom CAC measurement reclassifies a substantial number of subjects to different risk categories. In symptomatic patients with suspected CAD, detection of non-obstructive or obstructive CAD by CCT angiography is associated with increased all-cause mortality, and provides incremental risk stratification to CAC. Further studies are needed to assess the impact of CCT on clinical outcomes and its cost-effectiveness in different clinical settings.