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Hypertrabeculated Left Ventricular Myocardium in Relationship to Myocardial Function and Fibrosis: The Multi-Ethnic

Nadine Kawel-Boehm1, Robyn L McClelland1, Filip Zemrak1

  • 1From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (N.K., C.Y.L., D.A.B.); Department of Biostatistics, University of Washington, Seattle, Wash (R.L.M.); William Harvey Research Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, London, England (F.Z., S.E.P.); Institute of Cardiovascular Science, University College London and The Barts Heart Centre, St. Bartholomew's Hospital, London, England (G.C., J.C.M.); Department of Internal Medicine, Division of Cardiology, Wake Forest University, Winston-Salem, NC (W.G.H.); Department of Radiology (B.A.) and Department of Medicine, Division of Cardiology (J.A.C.L.), Johns Hopkins University, Baltimore, Md.

Radiology
|April 19, 2017
PubMed

Insights

Increased left ventricle (LV) trabeculation, a marker of endocardial complexity, is linked to worse regional heart muscle function. This study found no association with diffuse fibrosis, suggesting hypertrabeculation may be a sign of underlying heart disease.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Cardiac MRI

Background:

  • Left ventricular (LV) trabeculation, characterized by intricate endocardial projections, is increasingly recognized in cardiovascular imaging.
  • The clinical significance of excessive LV trabeculation, particularly its association with myocardial function and fibrosis, remains an area of active investigation.

Purpose of the Study:

  • To investigate the relationship between the degree of left ventricular (LV) trabeculation and average regional myocardial function.
  • To determine if excess LV trabeculation is associated with diffuse myocardial fibrosis.

Main Methods:

  • A multicenter study utilizing cardiac magnetic resonance (MR) imaging from the Multi-Ethnic Study of Atherosclerosis (MESA) cohort.
  • Left ventricular (LV) trabeculation was quantified using the maximal apical fractal dimension (FD).
  • Associations between FD, peak regional systolic circumferential strain (Ecc), and T1 mapping (a marker of diffuse fibrosis) were analyzed using multivariable linear regression.

Main Results:

  • Higher fractal dimension (FD) quartiles, indicating greater LV trabeculation, were significantly associated with worse average regional systolic circumferential strain (Ecc) (P < .001).
  • Each unit increase in FD was associated with a 4.0% worsening in myocardial strain after adjustment.
  • No significant association was found between the degree of LV trabeculation and diffuse myocardial fibrosis as assessed by T1 mapping.

Conclusions:

  • Greater left ventricular (LV) trabeculation is associated with impaired average regional myocardial function.
  • The findings suggest that hypertrabeculation may be an epiphenomenon of underlying cardiovascular disease rather than a direct cause of diffuse fibrosis.

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