Cardiac MRI May Help Predict Outcome in Left Ventricular Noncompaction

By David Douglas

December 05, 2016

NEW YORK (Reuters Health) - As well as helping diagnose left ventricular noncompaction (LVNC), cardiac magnetic resonance imaging (CMR) may be effective at predicting outcome, according to new research.

The study, Dr. Daniele Andreini told Reuters Health by email, "documented a robust long-term prognostic value of CMR in patients with LVNC, showing that CMR is able to differentiate patients with a high rate of major cardiac events from those with good prognosis."

Dr. Andreini of the Centro Cardiologico Monzino, IRCCS, in Milan, Italy, and colleagues studied 113 patients with an echocardiographic diagnosis of LVNC. CMR confirmed this finding, they explain in a paper online November 14 in the Journal of the American College of Cardiology.

Over a mean follow-up of four years, 36 patients had cardiac events. There were five cardiac deaths, 16 heart failure hospitalizations, 10 ventricular arrhythmias, and five thromboembolic events.

LV fibrosis was detected by using late gadolinium enhancement (LGE) in 11 patients. Predictors of CEs were LV dilation and LGE assessment.

LGE was significantly associated with improved prediction of cardiac events, compared with clinical data and CMR functional parameters. This was true in all of three models developed to adjust for factors including increased left ventricular end-diastolic volume.

There were no cardiac events in patients without dilated cardiomyopathy and/or LGE.

"Particularly," Dr. Andreini said, "we found that detection of left ventricle fibrosis is a strong independent predictor of poor prognosis. Moreover, we observed that patients with a phenotype classified in the literature as 'dilated cardiomyopathy (DCM)-like,' exhibited a high rate of cardiac events. On the contrary, patients without DCM features and/or myocardial delayed enhancement showed an excellent prognosis without any cardiac event at 4-year follow-up."

"In summary," he concluded, "our findings suggest that hypertrabeculation meeting current diagnostic criteria for LVNC, in the absence of some features at CMR, most likely represent an anatomic variant of LV structure that does not necessarily denote a disease and has no significant impact on subjects prognosis. Therefore, also considering the results of a long-term follow-up study in athletes fulfilling LVNC criteria that did not reveal adverse events, caution should be used before introducing restrictions based on isolated LVNC pattern."

Dr. Steffen E. Petersen of Barts Heart Centre, London, co-author of an accompanying editorial, agreed.

"Even though excessive cardiac trabeculation found in imaging studies attracts one's attention, clinicians should move towards a more inclusive approach of considering symptoms and family history, together with more established deleterious imaging markers before diagnosing a patient with non-compaction cardiomyopathy which remains a poorly understood condition," he told Reuters Health by email.


J Am Coll Cardiol 2016.