Abstract 17739: Time relationship of Cerebral Vascular Accidents and Echocardiographic Diagnosis of Left Ventricular Non-compaction

Abstract

Background: Isolated left ventricular non-compaction (LVNC) in adults is an increasingly recognized cardiomyopathy. It is associated with cerebrovascular accidents (CVA), ventricular arrhythmias (VT), systolic dysfunction, and sudden cardiac death. We set out to better understand the time relationships of CVA and echocardiographic diagnosis in our adult LVNC population. Methods: We reviewed unique subject-adult echo reports performed at UIHC between January 2009 and March 2014 (n=20,597; mean follow up after echo was 27 months+/ -16 months); we identified subjects with echocardiographic diagnosis of LVNC. Retrospective chart review was then performed to evaluate clinical variables encompasses an average of 33+/-36 months [up to 23.7years]. Results: Hypertrabiculation of the LV was observed in 1.67% of all echo studies (n=354); of those 184 individuals met echo criteria for LVNC (0.89%), males represented 63% with mean age of 57+/-16 years. Majority with LVEF<35% (n=105, 57%) averaging 37+/-7% (n=184). Annual mortality was high (7.8%) with 34 subjects (18.4%) dying over the course of follow-up. Approximately one third of patients (n=57, 31%) experienced at least one CVA over the duration of study. First CVA preceded echo diagnosis by an average of 35+/-62 months in the majority of cases (n=20); in a substantial minority CVA was closely associated with echo diagnosis 4.8+/-6 days (n=8). In 4 subjects CVA occurred 17+/-7 months after echo diagnosis. Oral Anticoagulants (OAC) were prescribed in 27% of all subjects and more often in those with CVA events (36%). LVEF was statistically significantly lower in subjects with CVA (p=0.03) and LVEF<35% was more often associated with prescription of OAC (36% vs 17%). In the group with LVEF>35 (61+/-6%) CVA occurred in 12% (n=10) and of those OAC was prescribed in 40% (n=4/10). Conclusions: Patients with LVNC have a high incidence of CVA that often precedes echocardiographic diagnosis by years. OAC appear to be underutilized in patients with CVA and LVNC. Low EF appears to be associated with more events, however, CVA was also observed in a substantial number of subjects with relatively preserved LVEF. Future studies are needed to understand the value of primary thromboembolic prevention in this high-risk group.