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Updated: Nov 10, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
The prognostic role of CMR using global planimetric criteria in patients with excessive left ventricular
Francesca Macaione1,2, Antonella Meloni1, Vincenzo Positano1
1MRI Unit, Fondazione G. Monasterio CNR-Regione Toscana, Area della Ricerca S. Cataldo, Via Moruzzi 1, 56124, Pisa, Italy.
Insights
Global Grothoff's criteria and myocardial fibrosis predict cardiovascular events in left ventricular non-compaction (LVNC) patients. These findings aid in assessing prognosis and guiding diagnosis confirmation for LVNC using cardiovascular magnetic resonance (CMR).
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Cardiac MRI
Background:
- Cardiovascular magnetic resonance (CMR) is vital for assessing left ventricular non-compaction (LVNC).
- Current diagnostic criteria for LVNC lack universal acceptance and have limited prognostic data.
- Prognostic value of CMR findings and specific criteria needs further investigation.
Purpose of the Study:
- To evaluate the long-term prognostic significance of global Grothoff's criteria.
- To assess the predictive value of CMR findings for adverse cardiovascular events (CE) in LVNC patients.
- To determine if planimetric criteria improve LVNC diagnosis and prognosis.
Main Methods:
- Prospective enrollment of 78 patients with echocardiographic LVNC criteria.
- Quantification of cardiac function and assessment of Grothoff's criteria using cine CMR images.
- Detection of myocardial fibrosis via late gadolinium enhancement (LGE) imaging.
Main Results:
- Petersen's CMR criterion was met by all patients; 26 met global Grothoff's criteria.
- During a mean 44.2-month follow-up, 28 cardiovascular events occurred, including heart failure and ventricular tachycardia.
- Multivariate analysis identified positive global Grothoff's criteria (HR=3.33) and myocardial fibrosis (HR=2.41) as independent predictors of CE.
Conclusions:
- Global Grothoff's criteria and myocardial fibrosis are strong predictors of CE in LVNC diagnosed by CMR.
- A stepwise approach using global planimetric Grothoff's criteria is recommended for confirming LVNC diagnosis and prognosis.
- Positive global Grothoff's criteria correlate with increased ventricular arrhythmias in LVNC.
Objectives:
Although cardiovascular magnetic resonance (CMR) is widely used in the assessment of left ventricular non-compaction (LVNC), there are no universally accepted diagnostic criteria and limited data regarding their prognostic value. We assessed the long-term prognostic role of the planimetric global Grothoff's criteria and of the CMR findings in predicting adverse cardiovascular events (CE).
Methods:
We prospectively enrolled 78 patients (46.7 ± 18.7 years, 33.3% females) with documented positive Jenni's echocardiographic criteria for LVNC. Cine images were used to quantify function parameters and to assess for the presence of all four quantitative Grothoff's criteria (global Grothoff's criteria). Late gadolinium enhancement (LGE) images were acquired to detect the presence of replacement myocardial fibrosis.
Results:
Petersen's CMR criterion for LVNC (NC/C ratio > 2.3 in at least one myocardial segment) was fulfilled in the whole population. Twenty-six patients fulfilled the global Grothoff's criteria (four out of four). The mean duration of the follow-up was 44.2 ± 27.4 months and 28 CE were registered: 10 ventricular tachycardias, 12 episodes of heart failure (HF), four strokes, and two cardiac deaths. In the multivariate analysis, the independent predictive factors for CE were positive global Grothoff's criteria (hazard ratio, HR = 3.33, 95% CI = 1.52-7.29; p = 0.003) and myocardial fibrosis (HR = 2.41, 95% CI = 1.08-5.36; p = 0.032).
Conclusions:
Positive global Grothoff's criteria and myocardial fibrosis were powerful predictors of CE in patients with a diagnosis of LVNC by CMR Petersen's criterion. Thus, we strongly suggest a step approach confirming the diagnosis of LVNC by using the global planimetric Grothoff's criteria, which showed a prognostic impact.
Key Points:
• Positive global Grothoff's criteria and replacement myocardial fibrosis were powerful predictors of cardiovascular events in patients with a diagnosis of LVNC by CMR Petersen's criterion. • Positive global Grothoff's criteria were associated with a higher frequency of ventricular arrhythmias in patients with a diagnosis of LVNC by CMR Petersen's criterion.
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