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Objectives This study evaluated the prognostic significance of cardiac magnetic resonance myocardial feature racking (CMR-FT) in patients with Brugada syndrome (BrS) to detect subclinical alterations and predict major adverse events (MAE). Methods and results CMR was performed in 106 patients (pts) with BrS. Biventricular global strain analysis was assessed using CMR-FT. Pts were followed for a mean of 11.1±3.5 years. The study cohort was subdivided according to the presence of a spontaneous type 1 ECG (sECG), into sBrS (BrS with sECG, n=34 (32.1%)) and diBrS (BrS with drug-induced type 1 ECG, n=72 (67.9%)). Both left and right ventricular (RV) ejection fraction were reduced within the normal range in sBrS pts. CMR-FT revealed morphological differences between sBrS and diBrS pts regarding RV strain (circumferential (%) (sBrS 7.9±2.9 vs diBrS −9.5±3.1, p=0.02) and radial strain (%) (sBrS 12.0±4.3 vs diBrS 15.4±5.4, p&amp;lt;0.01)). During follow up, MAE were noted in 12 pts (11.3%). The presence of a sECG was the strongest predictor for MAE (OR 0.70, 95% CI 0.53–0.90; p=0.008). RV global circumferential strain (GCS) was also associated with MAE (OR 0.16, 95% CI 0.03–0.82; p=0.03). A risk model which combined these two identified predictors showed a substantial risk increase for patients with both sECG and reduced RV-GCS. Conclusion Myocardial strain analysis detected early subclinical alterations, prior to apparent changes in myocardial function, in patients with BrS. Moreover, RV-GCS provided additional prognostic information on the occurrence of MAE during follow-up. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Deutsches Zentrum für Herz- und Kreislaufforschung (DZHK), German Centre for Cardiovascular Research

european heart journal

Risk stratification of patients with Brugada syndrome (BrS): the impact of myocardial strain analysis using cardiac magnetic resonance myocardial feature tracking (CMR-FT)