Prognostic Value of Late Gadolinium Enhancement Cardiac MRI–derived Entropy in Patients after Myocardial Infarction

Purpose To investigate the prognostic value of left ventricular (LV) and scar entropy for major adverse cardiac events (MACEs) and ventricular arrhythmias (VAs) in patients who have experienced myocardial infarction (MI). Materials and Methods The medical records of patients who underwent late gadolinium enhancement (LGE) cardiac MRI following MI between October 2015 and September 2022 were retrospectively evaluated for MACEs and VAs. LV and scar entropy data were derived from the probability distributions of the pixel signal intensities of the LV myocardium and scar tissue, respectively. Cox proportional hazards regression was performed to investigate the prognostic value of LV and scar entropy for predicting MACEs and VAs. Results A total of 226 patients (mean age, 59 years ± 11 [SD], 170 [75.2%] male; LV ejection fraction, 40% ± 15) were followed for a median of 21 (IQR, 15-31) months and experienced 72 MACEs, which included VAs in 19 patients. Compared with patients in the low-LV entropy group, the risk of MACEs was higher in the high-LV entropy group (P < .001). The multivariable analysis showed that LV entropy was independently associated with MACEs (hazard ratio, 2.50 [95% CI: 1.55, 4.04]; P < .001). Multivariable analysis also showed that scar entropy was a significant predictor of VA (hazard ratio, 3.01 [95% CI: 1.02, 8.87]; P = .045). Conclusion LV entropy and scar entropy derived from LGE cardiac MRI were significant predictors of MACEs and VAs, respectively, in patients who have experienced MI. Keywords: Cardiac Imaging Techniques, MRI, Myocardial Infarction, Prognosis, Major Adverse Cardiac Events Supplemental material is available for this article. © RSNA, 2025.