ISSN: 1885-5857 Impact factor 2023 7.2
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Original article
Left ventricular ejection fraction decline and cardiovascular events in suspected cardiomyopathy with excessive trabeculation: toward precision medicine

Deterioro de la fracción de eyección del ventrículo izquierdo y eventos cardiovasculares en la miocardiopatía con excesiva trabeculación: hacia la medicina de precisión

Guillem CasasabEduard Ródenas-AlesinaaJavier LimeresabClara Badia-MolinsabJosé M. Larrañaga-MoreiracJesús G. MirelisbdeJavier Navarrete-NavarrofJesús Martín-JiménezbegJuan E. Alcalá-LópezhJosefa González-CarrillobegAlbert TeisiRafaela Soler-FernándezjGisela Teixidó-TuràabeLaura Gutiérrez-GarcíaabPaula Fernández-ÁlvarezkPatricia Muñoz-CabellokJosé A. BarrabésaeColoma TirónelJulián Palomino-DozaemJosé Manuel García-PinillaenAntoni Bayés-GeníseiTomás Ripoll-VeraeoJuan Jiménez-JáimezehEduardo VillacortaepJuan Ramón Gimeno-BlanesbegEsther ZorioeqPablo García-PavíabderRoberto Barriales-VillaceAndrea GualaesSteffen E. PetersentuIgnacio Ferreira-GonzálezavJosé F. Rodríguez-Palomaresabe
Imagen extra
10.1016/j.rec.2025.01.011
Abstract
Introduction and objectives

Defining the probability of cardiomyopathy in individuals with excessive trabeculation of the left ventricle (ETLV) is an unmet clinical need. Our aims were: a) to describe the incidence and predictors of left ventricular ejection fraction (LVEF) decline and its correlation with major adverse cardiovascular events (MACE); and b) to identify prognostic factors in low-risk individuals.

Methods

Retrospective multicenter study in patients with ETLV and suspected cardiomyopathy. Two endpoints were analyzed: a) LVEF decline (> 10% absolute decrease in LVEF with LVEF <50% at follow-up); and b) MACE, a composite of heart failure, ventricular arrhythmias, systemic embolisms, or cardiovascular mortality. Cardiovascular magnetic resonance core-lab analysis was performed in low-risk individuals (LVEF ≥50% and negative late gadolinium enhancement).

Results

A total of 530 patients were included, with a mean age of 44±19 years and 44% were women. The mean LVEF was 49±16%. Over a median echocardiographic follow-up of 4.2 years, 29 patients (6%) showed a decline in LVEF. Late gadolinium enhancement (P=.004) and baseline atrial fibrillation (P=.006) were independently associated with LVEF decline. During a subsequent clinical follow-up of 3.8 years, 106 patients (20%) experienced MACE. Factors that remained associated with MACE after adjustment were baseline LVEF (P<.001), LVEF decline (P=.022), baseline atrial fibrillation (P=.001), and QRS ≥120 ms (P=.009). Among low-risk individuals, left atrial strain correlated with outcomes and distinguished subclinical cardiomyopathy from physiological excessive trabeculation.

Conclusions

In ETLV, a decline in LVEF predicts cardiovascular events beyond baseline LVEF. In low-risk individuals, left atrial strain defines the probability of cardiomyopathy. A comprehensive assessment might provide valuable insights for differential diagnosis and risk stratification in this population.

Keywords

Cardiomyopathy with excessive trabeculation
Subclinical cardiomyopathy
Physiologic excessive trabeculation
LVEF decline
Major adverse cardiovascular events

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