{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,14]],"date-time":"2026-11-14T07:44:18Z","timestamp":1794642258355,"version":"4.9.1"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2021,6,23]],"date-time":"2021-06-23T00:00:00Z","timestamp":1624406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Myocardial fibrosis is associated with clinical ventricular tachyarrhythmia (VTA) events in patients with non-ischaemic dilated cardiomyopathy (DCM). Subepicardial or mid-wall ring-like late gadolinium enhancement (LGE) has received increasing attention in recent years. The aim of this study was to investigate the relationship between ring-like LGE and VTAs in DCM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Patients diagnosed with non-ischaemic DCM who underwent cardiac magnetic resonance with LGE imaging at baseline were investigated. The composite outcome was the occurrence of VTAs defined as sustained ventricular tachycardia, ventricular fibrillation\/flutter, aborted sudden cardiac death (SCD), SCD, and appropriate implantable cardioverter-defibrillator intervention. The final cohort comprised 157 patients, including 36 (22.9%) in no LGE group, 48 (30.6%) in focal LGE group, 40 (25.5%) in multi-focal LGE group, and 33 (21%) in ring-like LGE group. Ring-like LGE group patients were younger compared to focal and multi-focal LGE group (P\u2009&amp;lt;\u20090.001) with higher left ventricular ejection fraction (33.0% vs. 24.4% vs. 22.1%, P\u2009&amp;lt;\u20090.001). After a median of 13\u2009\u00b1\u20097 months follow-up, compared to patients with no LGE, the hazard ratios (HRs) with 95% confidence intervals (CIs) for VTAs were 2.90 (0.56\u201315.06), 5.55 (1.21\u201325.44), and 11.75 (2.66\u201351.92) for patients with focal LGE, multi-focal LGE, and ring-like LGE, respectively. After multivariable adjustment, ring-like LGE group remained associated with increased risk of VTAs (adjusted HR 10.00, 95% CI 1.54\u201364.98; P\u2009=\u20090.016) independent of the global LGE burden<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The ring-like pattern of LGE is independently associated with an increased risk of VTAs in patients with non-ischaemic DCM.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjci\/jeab117","type":"journal-article","created":{"date-parts":[[2021,5,20]],"date-time":"2021-05-20T15:15:32Z","timestamp":1621523732000},"page":"1130-1138","source":"Crossref","is-referenced-by-count":64,"title":["Ring-like late gadolinium enhancement for predicting ventricular tachyarrhythmias in non-ischaemic dilated cardiomyopathy"],"prefix":"10.1093","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9933-8156","authenticated-orcid":false,"given":"Wensu","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Guangzhou Road 300, Nanjing 210029, China"},{"name":"Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Huaihai Road 99, Xuzhou 221000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Qian","sequence":"additional","affiliation":[{"name":"Department of Radiology, First Affiliated Hospital, Nanjing Medical University, Guangzhou Road 300, Nanjing 210029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinwei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Guangzhou Road 300, Nanjing 210029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongcheng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Guangzhou Road 300, Nanjing 210029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyong","family":"Qian","sequence":"additional","affiliation":[{"name":"Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Guangzhou Road 300, Nanjing 210029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hai","family":"Xu","sequence":"additional","affiliation":[{"name":"Internal Medicine, Northwell Health, 1350 Northern Blvd Suite 202, Manhasset, NY 11030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengen","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Guangzhou Road 300, Nanjing 210029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xing","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Guangzhou Road 300, Nanjing 210029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Guangzhou Road 300, Nanjing 210029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofeng","family":"Hou","sequence":"additional","affiliation":[{"name":"Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Guangzhou Road 300, Nanjing 210029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit R","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Medicine and Radiology, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Radiology, First Affiliated Hospital, Nanjing Medical University, Guangzhou Road 300, Nanjing 210029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0926-3846","authenticated-orcid":false,"given":"Jiangang","family":"Zou","sequence":"additional","affiliation":[{"name":"Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Guangzhou Road 300, Nanjing 210029, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,6,23]]},"reference":[{"key":"2021101918544322100_jeab117-B1","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1161\/CIRCULATIONAHA.116.027134","article-title":"Personalizing risk stratification for sudden death in dilated cardiomyopathy: the past, present, and future","volume":"136","author":"Halliday","year":"2017","journal-title":"Circulation"},{"key":"2021101918544322100_jeab117-B2","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1002\/ejhf.592","article-title":"2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"18","author":"Ponikowski","year":"2016","journal-title":"Eur J Heart Fail"},{"key":"2021101918544322100_jeab117-B3","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1056\/NEJMoa1608029","article-title":"Defibrillator implantation in patients with nonischemic systolic heart failure","volume":"375","author":"K\u00f8ber","year":"2016","journal-title":"N Engl J Med"},{"key":"2021101918544322100_jeab117-B4","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.jacc.2020.05.061","article-title":"Long-term outcomes of implantable cardioverter-defibrillator therapy in the SCD-HeFT","volume":"76","author":"Poole","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2021101918544322100_jeab117-B5","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/S0195-668X(03)00191-X","article-title":"Out-of-hospital cardiac arrest-the relevance of heart failure. The Maastricht Circulatory Arrest Registry","volume":"24","author":"Gorgels","year":"2003","journal-title":"Eur Heart J"},{"key":"2021101918544322100_jeab117-B6","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1016\/j.jcmg.2017.08.005","article-title":"Role of cardiac magnetic resonance in the diagnosis and prognosis of nonischemic cardiomyopathy","volume":"10","author":"Patel","year":"2017","journal-title":"JACC Cardiovasc Imaging"},{"key":"2021101918544322100_jeab117-B7","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1016\/j.jacc.2012.02.070","article-title":"Assessment of myocardial scarring improves risk stratification in patients evaluated for cardiac defibrillator implantation","volume":"60","author":"Klem","year":"2012","journal-title":"J Am Coll Cardiol"},{"key":"2021101918544322100_jeab117-B8","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1177\/0284185115580840","article-title":"Relationship of postcontrast myocardial T1 value and delayed enhancement to reduced cardiac function and serious arrhythmia in dilated cardiomyopathy with left ventricular ejection fraction less than 35%","volume":"57","author":"Tachi","year":"2016","journal-title":"Acta Radiol"},{"key":"2021101918544322100_jeab117-B9","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1016\/j.jcmg.2016.01.033","article-title":"Myocardial fibrosis assessment by LGE is a powerful predictor of ventricular tachyarrhythmias in ischemic and nonischemic LV dysfunction: a meta-analysis","volume":"9","author":"Disertori","year":"2016","journal-title":"JACC Cardiovasc Imaging"},{"key":"2021101918544322100_jeab117-B10","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1016\/j.cjca.2019.11.009","article-title":"A novel risk stratification score for sudden cardiac death prediction in middle-aged, nonischemic dilated cardiomyopathy patients: the ESTIMATED score","volume":"36","author":"Li","year":"2020","journal-title":"Can J Cardiol"},{"key":"2021101918544322100_jeab117-B11","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1016\/j.jcmg.2018.07.015","article-title":"Outcome in dilated cardiomyopathy related to the extent, location, and pattern of late gadolinium enhancement","volume":"12","author":"Halliday","year":"2019","journal-title":"JACC Cardiovasc Imaging"},{"key":"2021101918544322100_jeab117-B12","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.ijcard.2016.07.122","article-title":"Pattern of late gadolinium enhancement predicts arrhythmic events in patients with non-ischemic cardiomyopathy","volume":"222","author":"Shin","year":"2016","journal-title":"Int J Cardiol"},{"key":"2021101918544322100_jeab117-B13","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1161\/CIRCIMAGING.113.001768","article-title":"Prevalence of myocardial fibrosis patterns in patients with systolic dysfunction: prognostic significance for the prediction of sudden cardiac arrest or appropriate implantable cardiac defibrillator therapy","volume":"7","author":"Almehmadi","year":"2014","journal-title":"Circ Cardiovasc Imaging"},{"key":"2021101918544322100_jeab117-B14","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1186\/s12968-016-0300-z","article-title":"Objective criteria for septal fibrosis in non-ischemic dilated cardiomyopathy: validation for the prediction of future cardiovascular events","volume":"18","author":"Mikami","year":"2017","journal-title":"J Cardiovasc Magn Reson"},{"key":"2021101918544322100_jeab117-B15","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1093\/ehjci\/jew229","article-title":"Comprehensive multi-modality imaging approach in arrhythmogenic cardiomyopathy-an expert consensus document of the European Association of Cardiovascular Imaging","volume":"18","author":"Haugaa","year":"2017","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2021101918544322100_jeab117-B16","doi-asserted-by":"crossref","first-page":"2440","DOI":"10.1016\/j.jacc.2016.09.927","article-title":"Truncating FLNC mutations are associated with high-risk dilated and arrhythmogenic cardiomyopathies","volume":"68","author":"Ortiz-Genga","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"2021101918544322100_jeab117-B17","doi-asserted-by":"crossref","first-page":"1850","DOI":"10.1093\/eurheartj\/ehv727","article-title":"Proposal for a revised definition of dilated cardiomyopathy, hypokinetic non-dilated cardiomyopathy, and its implications for clinical practice: a position statement of the ESC working group on myocardial and pericardial diseases","volume":"37","author":"Pinto","year":"2016","journal-title":"Eur Heart J"},{"key":"2021101918544322100_jeab117-B18","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1002\/jmri.27160","article-title":"Age- and sex-specific reference values for atrial and ventricular structures in the validated normal Chinese population: a comprehensive measurement by cardiac MRI","volume":"52","author":"Zhuang","year":"2020","journal-title":"J Magn Reson Imaging"},{"key":"2021101918544322100_jeab117-B19","doi-asserted-by":"crossref","first-page":"e0208100","DOI":"10.1371\/journal.pone.0208100","article-title":"Prognostic implications of late gadolinium enhancement at the right ventricular insertion point in patients with non-ischemic dilated cardiomyopathy: a multicenter retrospective cohort study","volume":"13","author":"Yi","year":"2018","journal-title":"PLoS One"},{"key":"2021101918544322100_jeab117-B20","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1081\/JCMR-200053623","article-title":"Standardizing the definition of hyperenhancement in the quantitative assessment of infarct size and myocardial viability using delayed contrast-enhanced CMR","volume":"7","author":"Bondarenko","year":"2005","journal-title":"J Cardiovasc Magn Reson"},{"key":"2021101918544322100_jeab117-B21","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1161\/CIRCIMAGING.113.001144","article-title":"Late gadolinium enhancement on cardiac magnetic resonance predicts adverse cardiovascular outcomes in nonischemic cardiomyopathy: a systematic review and meta-analysis","volume":"7","author":"Kuruvilla","year":"2014","journal-title":"Circ Cardiovasc Imaging"},{"key":"2021101918544322100_jeab117-B22","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1016\/j.jcmg.2018.03.006","article-title":"The prognostic value of late gadolinium-enhanced cardiac magnetic resonance imaging in nonischemic dilated cardiomyopathy: a review and meta-analysis","volume":"11","author":"Becker","year":"2018","journal-title":"JACC Cardiovasc Imaging"},{"key":"2021101918544322100_jeab117-B23","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/j.hrthm.2020.12.003","article-title":"Prognostic value of cardiac magnetic resonance septal late gadolinium enhancement patterns for periaortic ventricular tachycardia ablation: heterogeneity of the anteroseptal substrate in nonischemic cardiomyopathy","volume":"18","author":"Nishimura","year":"2021","journal-title":"Heart Rhythm"},{"key":"2021101918544322100_jeab117-B24","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1161\/CIRCULATIONAHA.120.047640","article-title":"Prognostic value of nonischemic ringlike left ventricular scar in patients with apparently idiopathic nonsustained ventricular arrhythmias","volume":"143","author":"Muser","year":"2021","journal-title":"Circulation"},{"key":"2021101918544322100_jeab117-B25","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1111\/jce.12963","article-title":"Image integration to guide catheter ablation in scar-related ventricular tachycardia","volume":"27","author":"Yamashita","year":"2016","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2021101918544322100_jeab117-B26","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.jacep.2018.08.010","article-title":"Combined endocardial-epicardial versus endocardial catheter ablation alone for ventricular tachycardia in structural heart disease: a systematic review and meta-analysis","volume":"5","author":"Romero","year":"2019","journal-title":"JACC Clin Electrophysiol"},{"key":"2021101918544322100_jeab117-B27","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1002\/ehf2.12267","article-title":"Genetic determinants of heart failure: facts and numbers","volume":"5","author":"Czepluch","year":"2018","journal-title":"ESC Heart Fail"},{"key":"2021101918544322100_jeab117-B28","article-title":"Emerging concepts in arrhythmogenic dilated cardiomyopathy","author":"Zegkos","year":"2020","journal-title":"Heart Fail Rev"},{"key":"2021101918544322100_jeab117-B29","doi-asserted-by":"crossref","first-page":"e002149","DOI":"10.1161\/JAHA.115.002149","article-title":"Arrhythmogenic phenotype in dilated cardiomyopathy: natural history and predictors of life-threatening arrhythmias","volume":"4","author":"Spezzacatene","year":"2015","journal-title":"J Am Heart Assoc"},{"key":"2021101918544322100_jeab117-B30","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1093\/eurheartj\/ehu301","article-title":"Atlas of the clinical genetics of human dilated cardiomyopathy","volume":"36","author":"Haas","year":"2015","journal-title":"Eur Heart J"},{"key":"2021101918544322100_jeab117-B31","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1161\/CIRCGENETICS.110.937805","article-title":"Prevalence of desmosomal protein gene mutations in patients with dilated cardiomyopathy","volume":"3","author":"Elliott","year":"2010","journal-title":"Circ Cardiovasc Genet"},{"key":"2021101918544322100_jeab117-B32","doi-asserted-by":"crossref","first-page":"4595","DOI":"10.1093\/hmg\/ddq387","article-title":"De novo desmin-mutation N116S is associated with arrhythmogenic right ventricular cardiomyopathy","volume":"19","author":"Klauke","year":"2010","journal-title":"Hum Mol Genet"},{"key":"2021101918544322100_jeab117-B33","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1093\/eurjhf\/hfs119","article-title":"Phospholamban R14del mutation in patients diagnosed with dilated cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy: evidence supporting the concept of arrhythmogenic cardiomyopathy","volume":"14","author":"van der Zwaag","year":"2012","journal-title":"Eur J Heart Fail"},{"key":"2021101918544322100_jeab117-B34","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1093\/eurheartj\/ehu509","article-title":"Impact of genotype on clinical course in arrhythmogenic right ventricular dysplasia\/cardiomyopathy-associated mutation carriers","volume":"36","author":"Bhonsale","year":"2015","journal-title":"Eur Heart J"},{"key":"2021101918544322100_jeab117-B35","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.1016\/j.jacc.2009.01.044","article-title":"Left dominant arrhythmogenic cardiomyopathy a new clinical entity without a typical substrate of myocardial damage","volume":"53","author":"Di Bella","year":"2009","journal-title":"J Am Coll Cardiol"},{"key":"2021101918544322100_jeab117-B36","first-page":"326","article-title":"Dilated cardiomyopathy and arrhythmogenic left ventricular cardiomyopathy: a comprehensive genotype-imaging phenotype study","volume":"21","author":"Augusto","year":"2020","journal-title":"Eur Heart J Cardiovasc Imaging"}],"container-title":["European Heart Journal - Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/22\/10\/1130\/40758965\/jeab117.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/22\/10\/1130\/40758965\/jeab117.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,27]],"date-time":"2022-12-27T23:56:05Z","timestamp":1672185365000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article\/22\/10\/1130\/6308222"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,23]]},"references-count":36,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,6,23]]},"published-print":{"date-parts":[[2021,9,20]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjci\/jeab117","relation":{},"ISSN":["2047-2404","2047-2412"],"issn-type":[{"value":"2047-2404","type":"print"},{"value":"2047-2412","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,10,1]]},"published":{"date-parts":[[2021,6,23]]}}}