Heart failure & cardiomyopathies
Adverse Remodeling and Fibrosis Predict Outcomes in Excessive Trabeculation of the Left Ventricle: A Multiparametric Cardiac Magnetic Resonance (CMR) Risk Score
Authors' conclusion
CMR-based risk stratification in ETLV is primarily driven by adverse LV remodeling and fibrosis, whereas trabeculation indices provide only modest incremental prognostic value. In the absence of high-risk imaging features, ETLV likely represents a benign morphologic trait. This pragmatic multiparametric CMR score may support clinical decision-making in this debated phenotype.
Study context
- Population
- Patients with excessive trabeculation of the left ventricle (ETLV) undergoing CMRpatients with ETLV across 17 centers
- Participants
- 589 patientsEvents: 121 (21%)
- Predictors
- Indexed left ventricular (LV) end-diastolic volume, LV global longitudinal strain, and late gadolinium enhancement (LGE) extent
- Predicted outcome
- major adverse cardiovascular events (MACE): heart failure, ventricular arrhythmia, systemic embolism, or all-cause death
Methodological details17 centers, core-laboratory CMR analysis, development and validation of a CMR-based prediction model, independent validation cohort
- 17 centers
- Core-laboratory CMR analysis
- Development and validation of a CMR-based prediction model
- Independent validation cohort
Model performance
As reported in the abstract
C-statistic
Derivation
0.77
Validation
0.70
- Moderate prognostic performance and calibration
Further findings
| Outcome | Derivation | Validation |
|---|---|---|
| Incremental value of trabeculated mass percentage (TM%) added to the modelModestly improved discrimination | ||
| C-statistic | 0.79 | 0.72 |
- Incremental value of trabeculated mass percentage (TM%) added to the model — Derivation improvement
- P = 0.012
Incremental value of trabeculated mass percentage (TM%) added to the model
- Exploratory TM% ≥28% identified higher-risk patients
- TM% not predictive among individuals with normal indexed LV end-diastolic volume, preserved LV global longitudinal strain, and minimal LGE, who exhibited excellent outcomes
Baseline characteristics
- Mean age
- 43 ± 18 years
- Women
- 43%
- Mean LV ejection fraction
- 48% ± 14%
- Late gadolinium enhancement (LGE)
- 12%
- Median follow-up of 3.6 years
Prognosis, ETLV vs propensity-matched dilated cardiomyopathy cohort (197 patients)
- Prognosis comparable
- P = 0.557
- Propensity-matched
Original publication
Adverse Remodeling and Fibrosis Predict Outcomes in Excessive Trabeculation of the Left Ventricle: A Multiparametric CMR Risk Score. JACC Cardiovasc Imaging. Published 5 October 2026. doi:10.
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