{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T19:51:10Z","timestamp":1767988270530,"version":"3.49.0"},"reference-count":22,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"unspecified","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100014764","name":"China International Medical Foundation","doi-asserted-by":"publisher","award":["Z-2014-07-2101"],"award-info":[{"award-number":["Z-2014-07-2101"]}],"id":[{"id":"10.13039\/501100014764","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Key Project of National Natural Science Foundation of China","award":["82430066"],"award-info":[{"award-number":["82430066"]}]},{"DOI":"10.13039\/501100012166","name":"National Key R&D Program of China","doi-asserted-by":"crossref","award":["2021YFF0501400"],"award-info":[{"award-number":["2021YFF0501400"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100012166","name":"National Key R&D Program of China","doi-asserted-by":"crossref","award":["2021YFF0501404"],"award-info":[{"award-number":["2021YFF0501404"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2025,12,15]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the potential mediating role of left ventricular ejection fraction (LVEF) in the relationship between replacement fibrosis (assessed by late gadolinium enhancement (LGE)) and sudden cardiac death (SCD) post-myocardial infarction (MI) and also to assess this mediation effect in subgroups based on LVEF \u2264 35% and &gt; 35% according to implantable cardioverter-defibrillator (ICD) selection criterion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis was conducted on 917 post-MI patients (mean age: 56.3\u00b111.0 years, 88.8% male) who underwent cardiac MR from January 2017 to August 2021. The endpoint for SCDs included SCD, aborted SCD and appropriate ICD discharges. The association of LGE with LVEF was quantified using linear regression models. The associations of LGE and LVEF with SCDs were evaluated using competing risk models. Mediation analysis was then used to decompose the total effect of LGE on SCDs into direct and indirect (mediated through LVEF) effects using accelerated failure time models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Over a median follow-up of 63.3 (IQR, 43.6 to 76.6) months, 65 patients (7.1%) experienced SCDs. In all patients, LGE was significantly associated with lower LVEF (\u03b2=-0.35,\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001). Both LGE and LVEF independently predicted SCDs (subdistribution hazard ratio (sHR)=1.06,\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001; sHR=0.95,\n                      <jats:italic>p<\/jats:italic>\n                      =0.03, respectively). Mediation analysis showed that LVEF accounted for 19.7% of the total effect of LGE on SCDs (\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001). This mediation effect was 40.4% in patients with LVEF &gt; 35% (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.02), while no mediation was observed in patients with LVEF \u2264 35% (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.08).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>LVEF partially mediated the effect of LGE on the SCD, accounting for less than one-fifth of the total effect. LVEF alone inadequately captured the whole SCD risk, irrespective of whether LVEF is greater than 35% or 35% or less.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003799","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T14:40:29Z","timestamp":1767969629000},"page":"e003799","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Replacement fibrosis, left ventricular ejection fraction and sudden cardiac death in patients after myocardial infarction: a mediation analysis"],"prefix":"10.1136","volume":"13","author":[{"given":"Pengyu","family":"Zhou","sequence":"first","affiliation":[{"name":"Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaisaierjiang","family":"Aisikaier","sequence":"additional","affiliation":[{"name":"Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhixiang","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuan","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yun","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhuxin","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Peking University People's Hospital, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xi","family":"Jia","sequence":"additional","affiliation":[{"name":"Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xingrui","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yujie","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenqing","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fen","family":"Sa","sequence":"additional","affiliation":[{"name":"Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shu-Juan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiaxin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fengnian","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Radiology, West China School of Medicine, Sichuan University, Sichuan University affiliated Chengdu Second People's Hospital, Chengdu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minjie","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinxiang","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiuyu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1339-7476","authenticated-orcid":false,"given":"Shihua","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 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Cardiac Magnetic Resonance Visualization of the Myocardial Microstructure in Non-Ischemic Cardiomyopathies. CVIA 2024;9. doi:10.15212\/CVIA.2024.0042","DOI":"10.15212\/CVIA.2024.0042"},{"key":"2026010906401951000_13.1.e003799.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.hfc.2009.02.007"},{"key":"2026010906401951000_13.1.e003799.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.12.057"},{"key":"2026010906401951000_13.1.e003799.12","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2023-322803"},{"key":"2026010906401951000_13.1.e003799.13","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1016\/j.jcmg.2024.03.012","article-title":"Cardiac Magnetic Resonance Evaluation of LV Remodeling Post-Myocardial Infarction: Prognosis, Monitoring and Trial Endpoints","volume":"17","author":"Gissler","year":"2024","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026010906401951000_13.1.e003799.14","unstructured":"Pengyu Z , Shihua Z . Mediation of the relationship between myocardial replacement fibrosis and sudden cardiac death by left ventricular ejection fraction post-myocardial infarction. Fuwai Hospital, Beijing, China Abstract from: Great Wall International Congress of Cardiology Asian Heart Society Congress; 2025."},{"key":"2026010906401951000_13.1.e003799.15","doi-asserted-by":"crossref","DOI":"10.1148\/radiol.222239","article-title":"AI Cardiac MRI Scar Analysis Aids Prediction of Major Arrhythmic Events in the Multicenter DERIVATE Registry","volume":"307","author":"Ghanbari","year":"2023","journal-title":"Radiology"},{"key":"2026010906401951000_13.1.e003799.16","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1016\/j.jcmg.2023.03.015","article-title":"Cardiac Magnetic Resonance for Prophylactic Implantable-Cardioverter Defibrillator Therapy in Ischemic Cardiomyopathy: The DERIVATE-ICM International Registry","volume":"16","author":"Pontone","year":"2023","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026010906401951000_13.1.e003799.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.12.018"},{"key":"2026010906401951000_13.1.e003799.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.10.046"},{"key":"2026010906401951000_13.1.e003799.19","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht439"},{"key":"2026010906401951000_13.1.e003799.20","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.51.6.1173"},{"key":"2026010906401951000_13.1.e003799.21","doi-asserted-by":"crossref","first-page":"625","DOI":"10.2105\/AJPH.2018.304392","article-title":"The C-Word: The More We Discuss It, the Less Dirty It Sounds","volume":"108","author":"Hern\u00e1n","year":"2018","journal-title":"Am J Public Health"},{"key":"2026010906401951000_13.1.e003799.22","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00770.2011"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2025-003799","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T14:40:31Z","timestamp":1767969631000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2025-003799"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,9]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/openhrt-2025-003799"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2025-003799","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}