Fibrosis entropy is associated with life-threatening arrhythmia in nonischemic cardiomyopathy.
Abstract
Background: Greater precision is required for arrhythmic risk stratification of patients with nonischemic cardiomyopathy (NICM). We sought to evaluate whether fibrosis entropy, a measure of scar texture heterogeneity derived from late gadolinium enhancement cardiovascular magnetic resonance, has incremental utility to fibrosis presence for arrhythmic risk prediction in NICM.
Methods: In this prospective observational cohort study, fibrosis entropy was calculated for patients with NICM and fibrosis (late gadolinium enhancement positive, LGE+), including regions of core fibrosis, gray zone fibrosis and combined core and gray zone fibrosis. Patients with NICM and no fibrosis (LGE-) were included as a comparator group. Adjudicated follow-up for life-threatening arrhythmia included sudden cardiac death, aborted sudden cardiac death, or sustained ventricular tachycardia.
Results: Of 291 patients with LGE+ NICM, 38 (13.1%) experienced life-threatening arrhythmia over a median follow-up of 6.3 years. Core fibrosis entropy (per-SD hazard ratio [HR], 1.77 [95% CI, 1.25-2.52]; P=0.001), gray zone fibrosis entropy (HR, 1.97 [95% CI, 1.20-2.54]; P=0.004), and combined fibrosis entropy (HR, 1.98 [95% CI, 1.30-3.02]; P=0.004) were each associated with life-threatening arrhythmia after adjustment for variables used to determine implantable cardioverter-defibrillator candidacy in clinical practice (left ventricular ejection fraction ≤35% and New York Heart Association class >1) and remained associated after accounting for core and gray zone fibrosis mass. Left ventricular ejection fraction ≤35% was not associated with life-threatening arrhythmia (HR, 1.45 [95% CI, 0.77-2.74]; P=0.250). Integration of fibrosis presence with fibrosis entropy classified patients into low-, intermediate-, and high-arrhythmic-risk groups.
Conclusions: Deeper phenotypic characterization of scar using fibrosis entropy offers incremental utility to left ventricular ejection fraction and fibrosis presence for arrhythmic risk stratification in NICM.
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Author
Hammersley, Daniel J
Zaidi, Hassan A
Jones, Richard E
Hatipoglu, Suzan
Androulakis, Emmanuel
Balaban, Gabriel
Mach, Lukas
Lota, Amrit S
Khalique, Zohya
De Marvao, Antonio
Lopuszko, Aleksandra
Lazzari, Laura
Ravendren, Andrew
Gulati, Ankur
Baruah, Resham
Guha, Kaushik
Tayal, Upasana
Leyva, Francisco
Baksi, A John
Ware, James S
Lamata, Pablo
Pennell, Dudley J
Halliday, Brian P
Bishop, Martin J
Prasad, Sanjay K
Zaidi, Hassan A
Jones, Richard E
Hatipoglu, Suzan
Androulakis, Emmanuel
Balaban, Gabriel
Mach, Lukas
Lota, Amrit S
Khalique, Zohya
De Marvao, Antonio
Lopuszko, Aleksandra
Lazzari, Laura
Ravendren, Andrew
Gulati, Ankur
Baruah, Resham
Guha, Kaushik
Tayal, Upasana
Leyva, Francisco
Baksi, A John
Ware, James S
Lamata, Pablo
Pennell, Dudley J
Halliday, Brian P
Bishop, Martin J
Prasad, Sanjay K
Citations
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Date
2025-09-11
Type
Journal Article
Subject
Cardiology, Fribrosis, Arrhythmias, Cardiac
Collections
Citation
Hammersley DJ, Zaidi HA, Jones RE, Hatipoglu S, Androulakis E, Balaban G, Mach L, Lota AS, Khalique Z, De Marvao A, Lopuszko A, Lazzari L, Ravendren A, Gulati A, Baruah R, Guha K, Tayal U, Leyva F, Baksi AJ, Ware JS, Lamata P, Pennell DJ, Halliday BP, Bishop MJ, Prasad SK. Fibrosis Entropy Is Associated With Life-Threatening Arrhythmia in Nonischemic Cardiomyopathy. J Am Heart Assoc. 2025 Sep 16;14(18):e040517. doi: 10.1161/JAHA.124.040517. Epub 2025 Sep 11.
Journal / Source Title
Journal of the American Heart Association
DOI
10.1161/JAHA.124.040517
PMID
40932094
Publisher
Wiley-Blackwell
Publisher’s URL
https://pubmed.ncbi.nlm.nih.gov/40932094/