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Left ventricular ejection fraction decline and cardiovascular events in suspected cardiomyopathy with excessive

Guillem Casas1, Eduard Ródenas-Alesina2, Javier Limeres1

  • 1Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart), Brussels, Belgium.

Revista Espanola De Cardiologia (English Ed.)
|February 8, 2025
PubMed

Insights

Excessive trabeculation of the left ventricle (ETLV) with declining ejection fraction predicts cardiovascular events. Left atrial strain helps differentiate cardiomyopathy in low-risk ETLV patients.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Clinical Medicine

Background:

  • Excessive trabeculation of the left ventricle (ETLV) is a congenital heart anomaly where increased ventricular trabeculae may be associated with cardiomyopathy.
  • Defining the risk of cardiomyopathy in ETLV patients is clinically significant for prognosis and management.
  • Current diagnostic criteria and prognostic markers for ETLV require further elucidation.

Purpose of the Study:

  • To determine the incidence and predictors of left ventricular ejection fraction (LVEF) decline in ETLV patients.
  • To assess the correlation between LVEF decline and major adverse cardiovascular events (MACE).
  • To identify prognostic factors for cardiovascular outcomes, particularly in low-risk ETLV individuals.

Main Methods:

  • Retrospective multicenter study including 530 patients with ETLV and suspected cardiomyopathy.
  • Analysis of LVEF decline (absolute decrease >10% to <50%) and MACE (heart failure, arrhythmias, embolism, mortality).
  • Cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) in low-risk individuals (LVEF ≥50%, no LGE).

Main Results:

  • A total of 530 patients (mean age 44±19 years, 44% women) with a mean LVEF of 49±16% were included.
  • LVEF decline occurred in 6% of patients over a median follow-up of 4.2 years; LGE and atrial fibrillation predicted decline.
  • MACE occurred in 20% of patients over 3.8 years; baseline LVEF, LVEF decline, atrial fibrillation, and QRS duration predicted MACE.

Conclusions:

  • LVEF decline in ETLV patients is a significant predictor of cardiovascular events, independent of baseline LVEF.
  • In low-risk ETLV individuals, left atrial strain can differentiate subclinical cardiomyopathy from physiological ETLV.
  • Comprehensive assessment including imaging biomarkers is crucial for risk stratification and differential diagnosis in ETLV.
Abstract

Keywords:
Cardiomyopathy with excessive trabeculationDeterioro de la FEVIEventos cardiovasculares adversos mayoresExcesiva trabeculación fisiológicaLVEF declineMajor adverse cardiovascular eventsMiocardiopatía con excesiva trabeculaciónMiocardiopatía subclínicaPhysiologic excessive trabeculationSubclinical cardiomyopathy

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