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

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

Fecha de publicación: Fecha Ahead of Print:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Casas G
  • Ródenas-Alesina E
  • Limeres J
  • Badia-Molins C
  • Larrañaga-Moreira JM
  • Mirelis JG
  • Martín-Jiménez J
  • Alcalá-López JE
  • González-Carrillo J
  • Teis A
  • Soler-Fernández R
  • Teixidó-Turà G
  • Gutiérrez-García L
  • Fernández-Álvarez P
  • Muñoz-Cabello P
  • Barrabés JA
  • Tirón C
  • Palomino-Doza J
  • García-Pinilla JM
  • Bayés-Genís A
  • Ripoll-Vera T
  • Jiménez-Jáimez J
  • Villacorta E
  • Gimeno-Blanes JR
  • García-Pavía P
  • Barriales-Villa R
  • Guala A
  • Petersen SE
  • Ferreira-González I
  • Rodríguez-Palomares JF

Grupos

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.

Copyright © 2025 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Datos de la publicación

ISSN/ISSNe:
1885-5857, 1885-5857

REVISTA ESPANOLA DE CARDIOLOGIA  EDICIONES DOYMA S A

Tipo:
Article
Páginas:
934-944
PubMed:
39920987
Factor de Impacto:
0,385 SCImago ℠
Cuartil:
Q3 SCImago ℠

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Keywords

  • Cardiomyopathy with excessive trabeculation; Deterioro de la FEVI; Eventos cardiovasculares adversos mayores; Excesiva trabeculación fisiológica; LVEF decline; Major adverse cardiovascular events; Miocardiopatía con excesiva trabeculación; Miocardiopatía subclínica; Physiologic excessive trabeculation; Subclinical cardiomyopathy

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