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Prognostic Significance of Left Ventricular Noncompaction: Systematic Review and Meta-Analysis of Observational

Nay Aung^1,2, Sara Doimo³, Fabrizio Ricci⁴

¹William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Centre at Barts, Queen Mary University of London, Charterhouse Square, United Kingdom (N.A., M.M.S., C.P., S.P.W., F.Z., M.Y.K., P.B.M., S.E.P.).

Circulation. Cardiovascular Imaging

|January 22, 2020

Insights

Left ventricular noncompaction (LVNC) patients have similar cardiovascular mortality risks as dilated cardiomyopathy patients. Left ventricular ejection fraction, not trabeculation extent, influences adverse outcomes in LVNC.

Area of Science:

Cardiology
Cardiovascular Medicine
Genetics

Background:

Left ventricular noncompaction (LVNC) is a rare congenital heart defect.
The precise incidence of cardiovascular events in LVNC patients remains unclear.
Understanding LVNC-related morbidity and mortality is crucial for patient management.

Purpose of the Study:

To determine the incidence rate of cardiovascular events in patients with left ventricular noncompaction (LVNC).
To compare cardiovascular risks between LVNC patients and those with dilated cardiomyopathy.
To identify factors influencing adverse outcomes in LVNC.

Main Methods:

Systematic literature search of observational studies reporting adverse outcomes in LVNC.
Meta-analysis of pooled data from 28 studies including 2501 LVNC patients.
Primary endpoint: cardiovascular mortality; secondary endpoints: all-cause mortality, stroke, heart failure, arrhythmias, etc.

Main Results:

Pooled cardiovascular mortality rate was 1.92 per 100 person-years.
LVNC patients showed similar risks for cardiovascular mortality, thromboembolism, and ventricular arrhythmias compared to dilated cardiomyopathy.
LVNC patients had a higher incidence of heart failure hospitalizations.

Conclusions:

Left ventricular noncompaction (LVNC) patients face similar cardiovascular risks as dilated cardiomyopathy patients.
Left ventricular ejection fraction is a key determinant of adverse outcomes, more so than trabeculation extent.
These findings aid in risk stratification and management of LVNC.

Read full analysis

Abstract

Background:

Although left ventricular noncompaction (LVNC) has been associated with an increased risk of adverse cardiovascular events, the accurate incidence of cardiovascular morbidity and mortality is unknown. We, therefore, aimed to assess the incidence rate of LVNC-related cardiovascular events.

Methods:

We systematically searched observational studies reporting the adverse outcomes related to LVNC. The primary end point was cardiovascular mortality.

Results:

We identified 28 eligible studies enrolling 2501 LVNC patients (mean age, 46 years; male/female ratio, 1.7). After a median follow-up of 2.9 years, the pooled event rate for cardiovascular mortality was 1.92 (95% CI, 1.54-2.30) per 100 person-years. LVNC patients had a similar risk of cardiovascular mortality compared with a dilated cardiomyopathy control group (odds ratio, 1.10 [95% CI, 0.18-6.67]). The incidence rates of all-cause mortality, stroke and systemic emboli, heart failure admission, cardiac transplantation, ventricular arrhythmias, and cardiac device implantation were 2.16, 1.54, 3.53, 1.24, 2.17, and 2.66, respectively, per 100 person-years. Meta-regression and subgroup analyses revealed that left ventricular ejection fraction, not the extent of left ventricular trabeculation, had an important influence on the variability of incidence rates. The risks of thromboembolism and ventricular arrhythmias in LVNC patients were similar to dilated cardiomyopathy patients. However, LVNC patients had a higher incidence of heart failure hospitalization than dilated cardiomyopathy patients.

Conclusions:

Patients with LVNC carry a similar cardiovascular risk when compared with dilated cardiomyopathy patients. Left ventricular ejection fraction-a conventional indicator of heart failure severity, not the extent of trabeculation-appears to be an important determinant of adverse outcomes in LVNC patients. Registration: https://www.crd.york.ac.uk/PROSPERO/ Unique identifier: CRD42018096313.

Keywords:

cardiac imaging techniques cardiomyopathies meta-analysis prognosis

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