Long term clinical outcomes associated with CMR quantified isolated left ventricular non-compaction in adults

Impact of Cardiac Magnetic Resonance on the Diagnosis of Left Ventricular Noncompaction-A 15-Year Experience

The aim of this study was to assess the impact of cardiac magnetic resonance (CMR) on the diagnosis in patients with known or suspected left ventricular noncompaction (LVNC). We retrospectively reviewed the medical charts of 12,811 consecutive patients who had CMR studies between 2008 and 2022 in a large tertiary center. We included patients referred for CMR because of known or suspected LVNC. The study sample consisted of 333 patients, 193 (58.0%) male, median age 39.0 (26.8-51.0) years. Among 74 patients fulfilling the echocardiographic LVNC criteria, the diagnosis was confirmed in 54 (73.0%) cases. In 259 patients with ultrasound-based suspicion of LVNC, CMR led to an LVNC diagnosis in 82 (31.7%) patients. In both groups, CMR led to a new diagnosis in 89 cases (10 (13.5%) and 79 (30.5%)). A quantity of 38 (5.4%) patients were diagnosed with dilated cardiomyopathy, 11 (1.4%) patients were diagnosed with hypertrophic cardiomyopathy, and 21 (4.1%) patients were diagnosed with unclassified cardiomyopathy. In four patients with suspected LVNC, a myocardial trabeculation was a secondary result of dilatation due to coronary heart disease. In five cases, valvular heart disease was found. Four patients were diagnosed with athlete's heart. Other diagnoses (arrhythmogenic right ventricular cardiomyopathy, peripartum cardiomyopathy, hypokinetic non-dilated cardiomyopathy, sarcoidosis, amyloidosis, and ventricular septum defect) were found in six patients. CMR is a valuable tool in the evaluation of cardiac muscle and in differentiating LVNC and other cardiac diseases.

Can left ventricular entropy by cardiac magnetic resonance late gadolinium enhancement be a prognostic predictor in patients with left ventricular non-compaction?

PURPOSE

Left ventricular non-compaction (LVNC) is considered rare; however, the use of cardiac magnetic resonance (CMR) has shown that its incidence is not uncommon, and its clinical presentation remains variable, with an uncertain prognosis. Risk stratification of major adverse cardiac events (MACE) in patients with LVNC remains complex. Therefore, this study aims to determine whether tissue heterogeneity from late gadolinium enhancement-derived entropy is associated with MACE in patients with LVNC.

METHODS

This study was registered in the Clinical Trial Registry (CTR2200062045). Consecutive patients who underwent CMR imaging and were diagnosed with LVNC were followed up for MACE, which was defined by heart failure, arrhythmias, systemic embolism, and cardiac death. The patients were divided into MACE and non-MACE groups. The CMR parameters included left ventricular (LV) entropy, LV ejection fraction (LVEF), LV end-diastolic volume, LV end-systolic volume (LVESV), and LV mass (LVM).

RESULTS

Eighty-six patients (age: 45.48 ± 16.64 years; female: 62.7%; LVEF: 42.58 ± 17.20%) were followed up for a median of 18 months and experienced 30 MACE events (34.9%). The MACE group showed higher LV entropy, LVESV, and LVM and lower LVEF than the non-MACE group. LV entropy [hazard ratio (HR): 1.710, 95% confidence interval (CI): 1.078-2.714, P = 0.023] and LVEF (HR: 0.961, 95% CI: 0.936-0.988, P = 0.004) were independent predictors of MACE (P <0.050) according to the Cox regression analysis. Receiver operating characteristic curve analysis revealed that the area under the curve of LV entropy was 0.789 (95% CI: 0.687-0.869, P < 0.001), LVEF was 0.804 (95% CI: 0.699-0.878, P < 0.001), and the combined model of LV entropy and LVEF was 0.845 (95% CI: 0.751-0.914, P < 0.050).

CONCLUSION

LGE-derived LV entropy and LVEF are independent risk indicators of MACE in patients with LVNC. The combination of the two factors was more conducive to improving the prediction of MACE.

Prognostic factors associated with left ventricular non-compaction: A PRISMA-compliant meta-analysis

BACKGROUND

Left ventricular non-compaction (LVNC) is a rare disease with a poor prognosis. Efforts to improve prognosis are limited by the quality and scope of the available evidence on prognostic factors.

METHODS

Pubmed, Embase, China National Knowledge Infrastructure, Cochrane Library, Wanfang, and Baidu Scholar were searched and all relevant studies that examined factors related to LVNC prognosis, published before January 2021, were retrieved. Study quality evaluation and data extraction were independently completed by two authors. Statistical analyses were performed using STATA 15.0 software.

RESULTS

A total of 20 cohort studies were included in this study, with a total of 1910 patients. The results of the meta-analysis are as follows: New York Heart Function Association (NYHA) class III/IV (hazard ratio [HR] = 3.93, 95% confidence interval [CI]: 1.66-9.29), (NT-proBNP) increased (HR = 1.98, 95% CI: 1.10-3.58), left ventricular ejection fraction (LVEF) decreased (HR = 1.04, 95% CI: 1.03-1.06), left ventricular end-diastolic diameter (LVEDD) increased (HR = 1.03, 95% CI: 1.01-1.06) was an independent poor prognostic factor, and body mass index (HR = 0.80, 95% CI: 0.64-0.98) was an independent protective factor. Creatinine (CR) level (HR = 1.09, 95% CI: 0.95-1.25) and late gadolinium-enhanced (LGE) imaging (HR = 3.1, 95% CI: 0.85-11.31) has no statistical significance in the prognosis of LVNC.

CONCLUSION

In LVNC patients, NYHA class III/IV, elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, decreased LVEF, and increased LVEDD may lead to poor prognosis, and increased body mass index may improve the prognosis of LVNC. Further clinical research with large sample sizes and long-term follow-ups should be conducted.

PROSPERO REGISTRATION NUMBER

42020152706.

Left Ventricular Non-Compaction: Review of the Current Diagnostic Challenges and Consequences in Athletes

Left ventricular non-compaction (LVNC) is a complex clinical condition with no diagnostic gold standard. At present, there is trepidation about the accuracy of the diagnosis, the correlation to clinical outcomes and the long-term medical management. This article reviews the current imaging criteria, the limitations of echocardiography and cardiac magnetic resonance and the consequences of LV hypertrabeculation in athletes.