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Left ventricular noncompaction: the importance of identifying high-risk patients within the scope of left ventricular hypertrabeculation
Session:
CO 21 - Miocardiopatias
Speaker:
José Miguel Ramos Viegas
Congress:
CPC 2021
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Comunicações Orais
FP Number:
---
Authors:
José Miguel Viegas; Sílvia Aguiar Rosa; Pedro Brás; Alexandra Castelo; Vera Ferreira; Fernanda Gameiro; Pedro Rio; João Abreu; Ana Teresa Timóteo; Ana Galrinho; Luísa Moura Branco; Rui Cruz Ferreira
Abstract
<p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:#538135">Introduction: </span></span></span></strong></span></span><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">Prominent left ventricular (LV) trabeculation is frequently encountered, however LV noncompaction (LVNC) criteria are not always fulfilled. The clinical and prognostic significance of these findings remains unclear.</span></span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:#538135">Objectives: </span></span></span></strong></span></span><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">To characterize the patients (P) with echocardiographic suspicion of LVNC and to assess clinical outcomes.</span></span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:#538135">Methods: </span></span></span></strong></span></span><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">Retrospective single-centre study that included all echocardiograms between January 2018 and June 2020 perceiving LV hypertrabeculation. The cohort underwent d<span style="background-color:white"><span style="color:black">iagnostic assessment for LVNC by</span></span> Chin and Jenni criteria. Baseline characteristics were evaluated. Composite endpoint of cardiovascular death, heart failure (HF) hospitalization, ventricular arrythmias (VA) and nonfatal stroke was considered.</span></span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:#538135">Results: </span></span></span></strong></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif">51P, 75% male, mean age 50±</span></span>18 years. 35P (69%) had associated heart conditions, of which 57% had other known cardiomyopathy (mainly dilated cardiomyopathy), 14% congenital, 26% ischemic and 3% valvular heart disease. 2P were in postpartum period and 1P was an athlete. Family history of cardiomyopathy was present in 8P (16%). 12P underwent genetic testing, with TTN and MYH7 mutations being the most frequently detected. Prior clinical HF was reported in 53%, previous stroke in 14%, and non-sustained and sustained VA in 24% and 4%, respectively. Mean NYHA classification was 1.8±0.7, with 31% being asymptomatic. </span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif">The prevalence of LVNC by Chin criteria was 31% and by Jenni criteria was 55%. 32P (63%) met at least one LVNC criteria. This group was younger (45±18 vs 59±15, p= 0.004), had higher NT-proBNP levels (3644±2819 vs 389±640, p= 0.048) and QRS fragmentation (59% vs 21%, p= 0.027). Significantly higher LV end-diastolic volume (84(41) vs 64(28)ml/m2, p= 0.008) and end-systolic volume (51(37) vs 35(20)ml/m2, p= 0.004), along with lower LV ejection fraction (39±12 vs 49±13%, p= 0.009) and global longitudinal strain (-11±5 vs -17±4%, p= 0.003) were noticed. P who met LVNC criteria also had higher number of affected LV segments (6.4±1.8 vs 4.2±1.6, p <0.001). </span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif">Over a mean follow-up of 18±9 months, the incidence of composite endpoint was 35%. Univariate Cox analysis showed a significant association between the presence of LVNC criteria and adverse outcomes (HR: 5.108, 95%CI: 1.682-11.236, p= 0.030) (Fig.1).</span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:#538135">Conclusion: </span></span></span></strong></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif">LV hypertrabeculation can be encountered in a variety of clinical scenarios and often overlaps with other heart diseases. P satisfying criteria for LVNC had more impairment in LV performance and worse clinical outcomes.</span></span></p>
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