Risk stratification in non-ischemic cardiomyopathy remains challenging, as left ventricular ejection fraction alone is insufficient to predict arrhythmic events. ESC 2025 analysis assessed cardiovascular magnetic resonance parameters to identify patients at high risk of major arrhythmic adverse cardiac events. 

Data from 1,297 patients with EF < 50% were analyzed, excluding specific cardiomyopathy etiologies. The composite risk score incorporated indexed LV end-diastolic volume, late gadolinium enhancement segment count, left atrial coupling index, and global longitudinal strain.

During follow-up, 8.3% of patients experienced MAACE. The CMR-derived risk score demonstrated superior predictive performance compared with EF < 35%, identifying patients with a 5.3% one-year MAACE risk versus significantly lower risk in those with low scores. 

The model showed high sensitivity and negative predictive value, supporting its utility in guiding implantable cardioverter defibrillator decisions and improving arrhythmic event prediction in this population.