Left Ventricular Hypertrabeculation and Prognosis in Dilated Cardiomyopathy

Area of Science:

• Cardiology
• Genetics
• Imaging

Background:

• Left ventricular (LV) hypertrabeculation, previously known as LV noncompaction, is a myocardial condition associated with adverse cardiovascular events.
• Its prevalence and prognostic significance in dilated cardiomyopathy (DCM) across different genetic subtypes require further investigation.

Purpose of the Study:

• To evaluate the embolic risk in patients with DCM based on the presence of LV hypertrabeculation.
• To determine the prevalence and prognostic relevance of LV hypertrabeculation across various DCM genotypes.

Main Methods:

• Cardiac magnetic resonance imaging and genetic testing were performed on 1160 DCM patients from 22 international centers.
• Follow-up assessed embolic events, advanced heart failure, and major ventricular arrhythmias.

Main Results:

• LV hypertrabeculation was identified in 30.5% of patients and was not linked to increased embolic risk, ventricular arrhythmias, or advanced heart failure.
• Atrial fibrillation and reduced LV ejection fraction were associated with embolic events.
• Prevalence varied by genotype, with higher rates in motor sarcomeric, TTN, and genotype-negative cases.

Conclusions:

• LV hypertrabeculation is prevalent in DCM but does not predict adverse outcomes or necessitate different clinical management.
• Embolic risk is low in DCM patients with hypertrabeculation, even with reduced LV ejection fraction if in sinus rhythm, not supporting prophylactic anticoagulation.