Left ventricular ejection fraction decline and cardiovascular events in suspected cardiomyopathy with excessive trabeculation: toward precision medicine.

Fecha de publicación: 05/02/2025

Autores de IIS La Fe

Esther Zorio Grima

Autor

Participantes ajenos a IIS La Fe

Casas, Guillem
Rodenas-Alesina, Eduard
Limeres, Javier
Badia-Molins, Clara
Larranaga-Moreira, Jose M
Mirelis, Jesus G
Navarrete-Navarro, Javier
Martin-Jimenez, Jesus
Alcala-Lopez, Juan E
Gonzalez-Carrillo, Josefa
Teis, Albert
Soler-Fernandez, Rafaela
Teixido-Tura, Gisela
Gutierrez-Garcia, Laura
Fernandez-Alvarez, Paula
Munoz-Cabello, Patricia
Barrabes, Jose A
Tiron, Coloma
Palomino-Doza, Julian
Manuel Garcia-Pinilla, Jose
Bayes-Genis, Antoni
Ripoll-Vera, Tomas
Jimenez-Jaimez, Juan
Villacorta, Eduardo
Gimeno-Blanes, Juan Ramon
Garcia-Pavia, Pablo
Barriales-Villa, Roberto
Guala, Andrea
Petersen, Steffen E
Ferreira-Gonzalez, Ignacio
Rodriguez-Palomares, Jose F

Grupos

Cardiopatías familiares, muerte súbita y mecanismos de enfermedad (CAFAMUSME)

Investigador Principal

Aitana Braza Boils

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: Retrospectivemulticenter 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=120ms (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.

Datos de la publicación

ISSN/ISSNe:: 1885-5857, 1885-5857
Tipo:: Article
Páginas:: -
DOI:: 10.1016/j.rec.2025.01.011
Factor de Impacto:: 0,385 SCImago ℠
Cuartil:: Q3 SCImago ℠

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RED INVESTIGACION (RECAVA)

RD06/0014/0004 . INSTITUTO DE SALUD CARLOS III; FUNDACION PARA LA INV BIOMEDICA- HOSPITAL GREGORIO MARAÑON; FUNDACIÓN PARA LA INVESTIGACIÓN DEL HOSPITAL UNIVERSITARIO LA FE DE LA COMUNIDAD VALENCIANA . 2006