Left Ventricular Hypertrabeculation Is Not Associated With Cardiovascular Morbity or Mortality: Insights From the Eurocmr Registry.

Zahra Raisi‐Estabragh ,Herbert Frank,Henning Steen,Saidi A Mohiddin ,Günter Pilz,Heiko Mahrholdt,Oliver Bruder,Filip Zemrak,Anja Wagner,Albert C Van Rossum,Massimo Lombardi,Detlev Nothnagel,Christina Deluigi ,Juerg Schwitter,Steffen E Petersen,Mohammed Y Khanji ,Steffen Schneider,Eike Nagel,Sanjay Prasad ,Thorsten Dill

doi:10.3389/fcvm.2020.00158

Abstract

Aim: Left ventricular non-compaction (LVNC) is perceived as a rare high-risk cardiomyopathy characterized by excess left ventricular (LV) trabeculation. However, there is increasing evidence contesting the clinical significance of LV hyper-trabeculation and the existence of LVNC as a distinct cardiomyopathy. The aim of this study is to assess the association of LV trabeculation extent with cardiovascular morbidity and all-cause mortality in patients undergoing clinical cardiac magnetic resonance (CMR) scans across 57 European centers from the EuroCMR registry.Methods and Results: We studied 822 randomly selected cases from the EuroCMR registry. Image acquisition was according to international guidelines. We manually segmented images for LV chamber quantification and measurement of LV trabeculation (as per Petersen criteria). We report the association between LV trabeculation extent and important cardiovascular morbidities (stroke, atrial fibrillation, heart failure) and all-cause mortality prospectively recorded over 404 ± 82 days of follow-up. Maximal non-compaction to compaction ratio (NC/C) was mean (standard deviation) 1.81 ± 0.67, from these, 17% were above the threshold for hyper-trabeculation (NC/C > 2.3). LV trabeculation extent was not associated with increased risk of the defined outcomes (morbidities, mortality, LV CMR indices) in the whole cohort, or in sub-analyses of individuals without ischaemic heart disease, or those with NC/C > 2.3.Conclusion: Among 882 patients undergoing clinical CMR, excess LV trabeculation was not associated with a range of important cardiovascular morbidities or all-cause mortality over ~12 months of prospective follow-up. These findings suggest that LV hyper-trabeculation alone is not an indicator for worse cardiovascular prognosis.

Highlights

Left ventricular non-compaction cardiomyopathy (LVNC) is perceived as a rare genetic cardiomyopathy characterized by abnormal arrest of in-utero myocardial compaction [1]
The proportion of individuals in our study with NC/C >2.3 in at least one segment was high (17%, n = 142), this did not translate to an exaggerated rate of adverse events
This study adds to the growing evidence that left ventricular (LV) hypertrabeculation in isolation is not a predictor of risk and does not mandate further investigation or follow-up

Summary

Introduction

Left ventricular non-compaction cardiomyopathy (LVNC) is perceived as a rare genetic cardiomyopathy characterized by abnormal arrest of in-utero myocardial compaction [1]. Studies of healthy cohorts have identified fulfillment of the LVNC imaging criteria in a high proportion of individuals with no clear association to adverse outcomes [9,10,11]. Similar findings have been reported in small studies of asymptomatic athletes and healthy pregnant women [12,13,14] These findings have been replicated in single center studies of symptomatic individuals and those with known structural heart disease [15, 16]. A multicenter study of individuals diagnosed with LVNC reports better than expected outcomes with no prognostic impact of LV trabeculation beyond known parameters such as left ventricular ejection fraction (LVEF) [17]

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