Left Ventricular Hypertrabeculation Is Not Associated With Cardiovascular Morbity or Mortality: Insights From the Eurocmr Registry

Filip Zemrak; Zahra Raisi-Estabragh; Mohammed Y Khanji; Saidi A Mohiddin; Oliver Bruder; Anja Wagner; Massimo Lombardi; Juerg Schwitter; Albert C van Rossum; Günter Pilz; Detlev Nothnagel; Henning Steen; Eike Nagel; Sanjay K Prasad; Christina C Deluigi; Thorsten Dill; Herbert Frank; Steffen Schneider; Heiko Mahrholdt; Steffen E Petersen

doi:10.3389/fcvm.2020.00158

Left Ventricular Hypertrabeculation Is Not Associated With Cardiovascular Morbity or Mortality: Insights From the Eurocmr Registry

Front Cardiovasc Med. 2020 Sep 22:7:158. doi: 10.3389/fcvm.2020.00158. eCollection 2020.

Authors

Filip Zemrak^{1

2}, Zahra Raisi-Estabragh^{1

2}, Mohammed Y Khanji^{1

2}, Saidi A Mohiddin^{1

2}, Oliver Bruder³, Anja Wagner⁴, Massimo Lombardi⁵, Juerg Schwitter⁶, Albert C van Rossum⁷, Günter Pilz⁸, Detlev Nothnagel⁹, Henning Steen¹⁰, Eike Nagel¹¹, Sanjay K Prasad^{12

13}, Christina C Deluigi¹⁴, Thorsten Dill¹⁵, Herbert Frank¹⁶, Steffen Schneider¹⁷, Heiko Mahrholdt¹⁸, Steffen E Petersen^{1

2}

Affiliations

¹ William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom.
² Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom.
³ Department of Cardiology and Angiology, Elisabeth-Krankenhaus Essen, Ruhr University Bochum, Bochum, Germany.
⁴ Department of Cardiology, St. Vincent's Medical Centre, Bridgeport, CT, United States.
⁵ I.R.C.C.S. Multimodality Cardiac Imaging, Policlinico San Donato, Milan, Italy.
⁶ Cardiac MR Centre, University Hospital (CHUV), Switzerland and Lausanne University, Lausanne, Switzerland.
⁷ Department of Cardiology, Amsterdam University Centres, Amsterdam, Netherlands.
⁸ Department of Cardiology, Clinic Agatharied, University of Munich, Munich, Germany.
⁹ Department of Cardiology, Klinikum Ludwigsburg, Ludwigsburg, Germany.
¹⁰ Medneo Group, Berlin, Germany.
¹¹ Institute for Experimental and Translational Cardiovascular Imaging DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, Partner Site RheinMain, University Hospital, Goethe University, Frankfurt, Germany.
¹² CMR Unit, Royal Brompton Hospital, London, United Kingdom.
¹³ National Heart and Lung Institute, London, United Kingdom.
¹⁴ Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
¹⁵ Department of Internal Medicine, Krankenhaus Benrath, Düsseldorf, Germany.
¹⁶ Department of Internal Medicine, University Hospital Tulln, Tulln, Austria.
¹⁷ Institut für Herzinfarktforschung, Ludwigshafen, Germany.
¹⁸ Department of Cardiology, Robert Bosch Medical Centre, Stuttgart, Germany.

Abstract

Aim: Left ventricular non-compaction (LVNC) is perceived as a rare high-risk cardiomyopathy characterized by excess left ventricular (LV) trabeculation. However, there is increasing evidence contesting the clinical significance of LV hyper-trabeculation and the existence of LVNC as a distinct cardiomyopathy. The aim of this study is to assess the association of LV trabeculation extent with cardiovascular morbidity and all-cause mortality in patients undergoing clinical cardiac magnetic resonance (CMR) scans across 57 European centers from the EuroCMR registry. Methods and Results: We studied 822 randomly selected cases from the EuroCMR registry. Image acquisition was according to international guidelines. We manually segmented images for LV chamber quantification and measurement of LV trabeculation (as per Petersen criteria). We report the association between LV trabeculation extent and important cardiovascular morbidities (stroke, atrial fibrillation, heart failure) and all-cause mortality prospectively recorded over 404 ± 82 days of follow-up. Maximal non-compaction to compaction ratio (NC/C) was mean (standard deviation) 1.81 ± 0.67, from these, 17% were above the threshold for hyper-trabeculation (NC/C > 2.3). LV trabeculation extent was not associated with increased risk of the defined outcomes (morbidities, mortality, LV CMR indices) in the whole cohort, or in sub-analyses of individuals without ischaemic heart disease, or those with NC/C > 2.3. Conclusion: Among 882 patients undergoing clinical CMR, excess LV trabeculation was not associated with a range of important cardiovascular morbidities or all-cause mortality over ~12 months of prospective follow-up. These findings suggest that LV hyper-trabeculation alone is not an indicator for worse cardiovascular prognosis.

Keywords: cardiac magnetic resonance; cardiomyopathy; left ventricular non-compaction; left ventricular trabeculation; mortality.

Copyright © 2020 Zemrak, Raisi-Estabragh, Khanji, Mohiddin, Bruder, Wagner, Lombardi, Schwitter, van Rossum, Pilz, Nothnagel, Steen, Nagel, Prasad, Deluigi, Dill, Frank, Schneider, Mahrholdt and Petersen.

Abstract

Grants and funding