Late gadolinium enhancement imaging and sudden cardiac death

Abstract The prediction and management of sudden cardiac death risk continue to pose significant challenges in cardiovascular care despite advances in therapies over the last two decades. Late gadolinium enhancement (LGE) on cardiac magnetic resonance—a marker of myocardial fibrosis—is a powerful non-invasive tool with the potential to aid the prediction of sudden death and direct the use of preventative therapies in several cardiovascular conditions. In this state-of-the-art review, we provide a critical appraisal of the current evidence base underpinning the utility of LGE in both ischaemic and non-ischaemic cardiomyopathies together with a focus on future perspectives and the role for machine learning and digital twin technologies.