{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:59:07Z","timestamp":1793318347683,"version":"4.5.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T00:00:00Z","timestamp":1730419200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"publisher","award":["RC-2024-2789983"],"award-info":[{"award-number":["RC-2024-2789983"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Left ventricular (LV) ring-like scar on cardiac magnetic resonance (CMR) has been linked to malignant arrhythmias in patients with non-ischaemic cardiomyopathy. This study aimed to perform a comprehensive evaluation of this phenotype and to identify risk factors for life-threatening arrhythmic events (LAEs), a composite of sudden cardiac death (SCD), aborted SCD, and sustained ventricular tachycardia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>One hundred and fifteen patients [median age 39 (interquartile range, IQR, 28\u201352), 42% females] were identified at 6 referral centres. Inclusion criteria were ring-like LV scar [\u22653 contiguous segments with sub-epicardial\/midwall late gadolinium enhancement (LGE) in the same slice] and one among: pathogenic\/likely pathogenic genetic variant, family history for cardiomyopathy, or arrhythmogenic cardiomyopathy diagnosis. During the study follow-up, survival free from LAEs was 60% (3.8 events\/100 patients\/year); at a median follow-up of 4.6 years (IQR 1.7\u20138.4) it was 84%. On multivariable analysis, anterior Q waves [hazard ratio (HR): 1.030, 95% confidence intervals (CI): 1.014\u20131.046, P &amp;lt; 0.001], QRS width (HR: 4.642, 95% CI: 1.296\u201316.628, P = 0.018), and LV end-diastolic volume index (LVEDVi; HR: 1.011, 95% CI: 1.001\u20131.021, per mL\/m2 increase, P = 0.040) were independently associated with LAEs; with good discrimination power (Harrell\u2019s C-index = 0.796). Three risk categories were identified: normal electrocardiogram (ECG), abnormal ECG and no LAEs predictive variables, abnormal ECG and \u22651 LAEs predictive variables, with a decreasing survival from 100 to 65% and 49%, respectively (Log-rank test = 0.015).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In this study, the LV ring-like scar phenotype was associated with a high rate of malignant arrhythmias in presence of anterior Q waves, QRS prolongation, and increased LVEDVi. A normal ECG identified a lower risk sub-group.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwae353","type":"journal-article","created":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T17:06:20Z","timestamp":1730480780000},"page":"1064-1074","source":"Crossref","is-referenced-by-count":14,"title":["Arrhythmic risk stratification in patients with left ventricular ring-like scar"],"prefix":"10.1093","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6895-0040","authenticated-orcid":false,"given":"Vanda","family":"Parisi","sequence":"first","affiliation":[{"name":"Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna , Via Giuseppe Massarenti 9, 40138 Bologna ,","place":["Italy"]},{"name":"Department of Medical and Surgical Sciences (DIMEC), University of Bologna , Via Irnerio 49, 40126 Bologna ,","place":["Italy"]},{"name":"European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4250-4859","authenticated-orcid":false,"given":"Maddalena","family":"Graziosi","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna , Via Giuseppe Massarenti 9, 40138 Bologna ,","place":["Italy"]},{"name":"European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis R","family":"Lopes","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital , W Smithfield, London EC1A 7BE ,","place":["UK"]},{"name":"Institute of Cardiovascular Science, University College London , Gower St, London WC1E 6BT ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"De Luca","sequence":"additional","affiliation":[{"name":"Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste , Via Pietro Valdoni 7, 34149 Trieste ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferdinando","family":"Pasquale","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna , Via Giuseppe Massarenti 9, 40138 Bologna ,","place":["Italy"]},{"name":"European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8520-152X","authenticated-orcid":false,"given":"Giacomo","family":"Tini","sequence":"additional","affiliation":[{"name":"Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University , Viale Regina Elena 324, 00161 Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9213-8565","authenticated-orcid":false,"given":"Mattia","family":"Targetti","sequence":"additional","affiliation":[{"name":"Cardiomyopathy Unit, Careggi University Hospital , Largo Brambilla 3, 50134 Florence ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria R","family":"Cueto","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital , W Smithfield, London EC1A 7BE ,","place":["UK"]},{"name":"Heart Failure and Cardiomyopathies Clinic, Germans Trias i Pujol University Hospital , Carretera de Canyet, 08916 Badalona, Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana R","family":"Moura","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital , W Smithfield, London EC1A 7BE ,","place":["UK"]},{"name":"Unidade Local de Sa\u00fade de Matosinhos , Rua Dr. Eduardo Torres 4464-513 Senhora da Hora ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaello","family":"Ditaranto","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna , Via Giuseppe Massarenti 9, 40138 Bologna ,","place":["Italy"]},{"name":"Department of Medical and Surgical Sciences (DIMEC), University of Bologna , Via Irnerio 49, 40126 Bologna ,","place":["Italy"]},{"name":"European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla","family":"Torlasco","sequence":"additional","affiliation":[{"name":"IRCCS, Istituto Auxologico Italiano, Department of Cardiology, Cardiomyopathy Unit, San Luca Hospital , Piazzale Brescia 20, 20149 Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nevio","family":"Taglieri","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna , Via Giuseppe Massarenti 9, 40138 Bologna ,","place":["Italy"]},{"name":"European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Nardi","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), University of Bologna , Via Irnerio 49, 40126 Bologna ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Lovato","sequence":"additional","affiliation":[{"name":"Pediatric and Adult Cardio-Thoracic and Vascular, Onco-Hematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via 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