Heart failure & cardiomyopathies
Adverse Remodeling and Fibrosis Predict Outcomes in Excessive Trabeculation of the Left Ventricle
- international retrospective study
- 17 centers
- core-laboratory cardiac magnetic resonance (CMR) analysis
- derivation and independent validation cohort
- propensity-matched comparison cohort
+4 more
- 17 centers
- core-laboratory cardiac magnetic resonance (CMR) analysis
- derivation and independent validation cohort
- propensity-matched comparison cohort
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)patients with ETLV across 17 centers, propensity-matched dilated cardiomyopathy cohort of 197
- Participants
- 589 patients
- Exposure
- CMR-based prediction model of major adverse cardiovascular events (MACE) derived from morphofunctional CMR parameters and validated in an independent cohort; incremental value of trabeculation indices
- ETLVn = 589
- dilated cardiomyopathyn = 197
Main finding
As reported in the abstract
- Heart failure
- Ventricular arrhythmia
- Systemic embolism
- All-cause death
ETLV
21%
121 of 589
Observational data: associations, not effects.
Further findings
Prognosis, propensity-matched ETLV vs dilated cardiomyopathy
- Prognosis was comparable
- P = 0.557
Baseline characteristics
- Mean age
- 43 ± 18 years
- Women
- 43%
- Mean left ventricular (LV) ejection fraction
- 48% ± 14%
- Late gadolinium enhancement (LGE)
- 12%
Model performance: indexed LV end-diastolic volume, LV global longitudinal strain, and LGE extent
- C-statistic in derivation
- 0.77
- C-statistic in validation
- 0.70
- moderate prognostic performance and calibration
Model performance with addition of TM%
- C-statistic in derivation
- 0.79
- P (derivation)
- P = 0.012
- C-statistic in validation
- 0.72
- 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
- exploratory threshold
Original publication
Summarised from the published abstract; every number is checked against it