Adverse Remodeling and Fibrosis Predict Outcomes in Excessive Trabeculation of the Left Ventricle: A Multiparametric CMR Risk Score.
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Casas Guillem, Rodenas-Alesina Eduard, Limeres Javier, Urio-Garmendia Garazi, Roque Albert, Muñoz-Cabello Patricia, Larrañaga-Moreira Jose M, Tassetti Luigi, Kumar Amudha, Emrich Tilman, Masi Ambra, Ramos Noemi, Martín-Álvarez Esteban, Pellizzon Amedeo, Garcia-Pinilla José Manuel, Tiron Coloma, González-Carrillo Josefa, Moro Claudio, Ripoll-Vera Tomás, Teis Albert, Lanzillo Chiara, Bermudez-Jimenez Francisco Jose, Zorio Esther, Villacorta Eduardo, Mora-Ayestaran Nerea, Schwitter Juerg, Varga-Szemes Akos, Rabbat Mark, Pontone Gianluca, Barriales-Villa Roberto, Aung Nay, Teixido-Tura Gisela, Guala Andrea, Petersen Steffen E, Ferreira-González Ignacio, Rodríguez-Palomares José F
Аннотация
OBJECTIVES: This study sought to develop and validate a cardiac magnetic resonance (CMR)-based model to predict major adverse cardiovascular events (MACE) and to assess the incremental prognostic value of trabeculation metrics.
METHODS: In this international retrospective study, 589 patients with ETLV across 17 centers underwent core-laboratory CMR analysis. The composite MACE endpoint included heart failure, ventricular arrhythmia, systemic embolism, or all-cause death. A prediction model was derived from morphofunctional CMR parameters and validated in an independent cohort. The incremental value of trabeculation indices was then assessed. Outcomes were further compared with a propensity-matched cohort of 197 patients with dilated cardiomyopathy.
RESULTS: Mean age was 43 ± 18 years, 43% were women, mean left ventricular (LV) ejection fraction was 48% ± 14%, and 12% had late gadolinium enhancement (LGE). Over a median follow-up of 3.6 years, 121 (21%) patients experienced MACE. A model including indexed LV end-diastolic volume, LV global longitudinal strain, and LGE extent demonstrated moderate prognostic performance (C-statistic 0.77 in derivation; 0.70 in validation) and calibration. Addition of trabeculated mass percentage (TM%) modestly improved discrimination (C-statistic 0.79 in derivation, P = 0.012; 0.72 in validation); an exploratory TM% ≥28% identified higher-risk patients. However, TM% was not predictive among individuals with normal indexed LV end-diastolic volume, preserved LV global longitudinal strain, and minimal LGE, who exhibited excellent outcomes. Prognosis was comparable in propensity-matched ETLV and dilated cardiomyopathy cohorts (P = 0.557).
CONCLUSIONS: 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.