Left Ventricular Hypertrabeculation and Prognosis in Dilated Cardiomyopathy.
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Mora-Ayestarán Nerea, Ramos-Lopez Noemi, Ochoa Juan Pablo, Ibargoyen Amaia Yuan, Claver-Garrido Eduard, Gómez-González Cristina, Amin Ahmad S, Gallego-Delgado María, Casas-Masnou Guillem, Navarro-Peñalver Marina, Larrañaga-Moreira Jose María, García-Pinilla José Manuel, Bermudez-Jimenez Francisco J, Mogollón-Jiménez Maria Victoria, Cabezón-Villalba Gonzalo, Bayes-Genis Antoni, Climent-Payá Vicente, Salguero-Bodes Rafael, García-Álvarez Ana, Brion María, Brugada Ramon, Zorio Esther, Ripoll-Vera Tomas, Peña-Peña María Luisa, Royuela Ana, Sánchez Miriam, Diez-Lopez Carles, Rodríguez González Elena, Poel Edwin, Villacorta Eduardo, Limeres-Freire Javier, Sabater-Molina María, Barriales-Villa Roberto, Lacuey-Lecumberri Gemma, Di Marco Andrea, Espinosa-Castro María Angeles, Bezzina Connie R, Rodríguez-Palomares José F, Basurte-Elorz María Teresa, Mirelis Jesus G, Garcia-Pavia Pablo
Аннотация
METHODS: Clinical data from 1160 patients with DCM evaluated by cardiac magnetic resonance imaging and genetic testing (n=997 [86%]) were collected from 22 international centers. End points included embolic events, advanced heart failure events, and major ventricular arrhythmias.
RESULTS: LV hypertrabeculation was identified in 354 patients (30.5%) by fractal analysis and in 343 (29.7%) according to Petersen criteria, with good concordance. After a median follow-up of 5.1 years (interquartile range, 2.8-7.4), embolic events occurred in 37 patients (3.2%), advanced heart failure in 62 (5.3%), and major ventricular arrhythmias in 136 (11.7%). Hypertrabeculation was not associated with increased embolic risk (hazard ratio, 1.5 [95% CI, 0.75-3.00]), even among patients in sinus rhythm with LV ejection fraction ≤40% (hazard ratio, 1.89 [95% CI, 0.7-5.5]). In contrast, atrial fibrillation and reduced LV ejection fraction were associated with embolic events (both P<0.01). LV hypertrabeculation was not associated with an increased risk of major ventricular arrhythmias or advanced heart failure; genotype, LV ejection fraction, and late gadolinium enhancement emerged as the main predictors of adverse outcomes. The prevalence of LV hypertrabeculation varied across genotypes, with the highest prevalence observed in patients with sequence variants in motor sarcomeric genes (58%), TTN (38%), and genotype-negative status (33%), and the lowest prevalence observed among those with variants in cytoskeletal/Z-disk (7%) and nuclear envelope (5%) genes. Hypertrabeculation was not associated with adverse outcomes within any genotype.
CONCLUSIONS: Although LV hypertrabeculation is common in DCM, it is not associated with worse outcomes and should not prompt differential clinical management. The embolic risk in patients with DCM and hypertrabeculation is low, including in those with reduced LV ejection fraction without atrial fibrillation, and does not support prophylactic anticoagulation in these patients.