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Introduction Carcinoid heart disease (CHD) is a paraneoplastic complication of neuroendocrine tumors (NETs). It confers poor prognosis with survival half that of NET patients without cardiac involvement at 3 years. The pathogenesis is not fully understood, but the consensus is that vasoactive substances, mainly serotonin, drive fibrotic destruction of cardiac tissue.Fibrosis can be detected on cardiac magnetic resonance imaging (CMRI) via tissue characterisation with late gadolinium enhancement (LGE). The pattern and extent of LGE determines prognosis in several non-ischaemic cardiomyopathies.Our aim is to assess the distribution of LGE in our cohort of patients with CHD.Methods This is a retrospective cohort study of patients diagnosed with CHD between 2006 to 2023 at a larger tertiary centre, and had CMRI with LGE as a part of their routine care. Patients with a solely ischaemic pattern of LGE or ventricular insertion point LGE were excluded.Results Sixty-four patients were identified (mean age 65 ± 9 years, 50% male), with midgut NETs being the most common (77%) and liver metastases present in 92%. LGE was present in 17 (27%) patients, most commonly affecting the tricuspid valve (TV) leaflets (37 %), right atrium (RA) (26 %) and right ventricular (RV) free wall (14 %). LGE uptake was also seen in the RV outflow tract (RVOT) and pulmonary valve (PV) leaflets. In one case of a large patent foramen ovale (PFO) LGE was seen to affect all four valves and both atria. Most of the LGE positive group (82%) had passed away by the time of data analysis compared to 66% in the LGE negative group, however, this was not statistically significant ( p = 0.35).Conclusions Although it is well known that CHD is a result of fibrosis, the pathogenesis of this and relevance of markers of fibrosis such as LGE on CMR are poorly understood. To our knowledge there is no data exploring the presence of LGE on CMR in CHD. This is an area where future research should be directed, as LGE in other non-ischaemic cardiomyopathies has proven important in determining outcomes.