Objective:

To develop an exploratory model integrating late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) scar characteristics with computational VT simulation to discriminate sustained VT, compared against LVEF.

Approach:

• Study Design: Single-centre retrospective study enrolling patients with suspected structural heart disease (SHD) who underwent LGE-CMR.
• Patient Analysis: Patients with LGE-positive underwent quantitative scar analysis, personalized digital heart-twin reconstruction, and virtual electrophysiological simulation.

Key Findings:

• Among82patients(meanage59.1years;82.9%male),15experiencedsustainedVT.LowerLVEFwasassociatedwithsustainedVT(P=0.008;C-statistic:0.730),aswasvisualLGEpositivity(P=0.023;C-statistic:0.634).AmongLGE-positivepatients,thosewithsustainedVThadalargercorescar[10.0[5.9,14.8]%vs.2.2[1.1,4.7]%;P<0.001],largergreyzone[14.0[10.9,14.7]%vs.5.7[2.3,9.2]%;P<0.001],higherVTinducibility[50.0[22.9,66.9]%vs.0(0,21.1)%;P<0.001],andagreaternumberofinducibleVTcircuits[2[2,4]vs.0[0,2];P<0.001].AnintegratedLGE-VTsimindex,derivedfromthesefourparameters,effectivelydiscriminatedsustainedVT(C-statistic:0.816)andremainedindependentlyassociatedwithsustainedVTafteradjustingforLVEF(OR:1.029;95%CI:1.008–1.051;P=0.007).

Interpretation:

The LGE-VTsim index represents an exploratory parameter in identifying patients at risk of sustained VT in SHD, beyond LVEF.

Limitations:

• Single-centre study may limit generalizability.
• Retrospective design may introduce bias.

Conclusion:

The study indicates that integrating quantitative LGE-CMR scar assessment with computational simulation may provide insights into risk stratification for sustained VT in patients with SHD.