Department of Internal Medicine Section on Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Department of Internal Medicine Section on Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Am J Cardiol. 2014 Mar 15;113(6):1018-23. doi: 10.1016/j.amjcard.2013.12.008. Epub 2013 Dec 25.
The distinction between normal right ventricular (RV) trabeculations from abnormal has been difficult. We evaluated whether RV volume and function are related to left ventricular (LV) noncompaction (NC) cardiomyopathy and clinical events. Trabeculations or possible LVNC by cardiac magnetic resonance imaging was retrospectively observed among 105 consecutive cases. We measured LV end-systolic (ES) noncompacted-to-compacted ratio, RV ejection fraction (EF), RV apical trabecular thickness, and RV end-diastolic (ED) noncompacted-to-compacted ratio. A control group of 40 subjects was also reviewed to assess the exploratory measures. Comparing those with LVES noncompacted-to-compacted ratio ≥2, those with LVES noncompacted-to-compacted ratio <2, and the normal control group, adjusted means for RV apical trabecular thickness and RVED noncompacted-to-compacted ratio were generated. Logistic regression was used to evaluate the association of composite events traditionally associated with LVNC with RVEF after adjustment for aforementioned covariates, cardiovascular risk factors, delayed enhancement, LVEF, and LVES noncompacted-to-compacted ratio. Analysis of RV morphology found greater apical trabecular thickness among those with LVES noncompacted-to-compacted ratio ≥2 compared with those with LVES noncompacted-to-compacted ratio <2 or normal control group (31 ± 5 vs 27 ± 2.6 vs 22 ± 4 mm; p = 0.03 and p = 0.003, respectively). There was no difference between the groups in relation to the RVED noncompacted-to-compacted ratio. Low RVEF and LVES noncompacted-to-compacted ratio ≥2 had significant association with clinical events in this population even after adjusting for clinical and imaging parameters (p = 0.04 and p <0.001, respectively). In conclusion, RV dysfunction in a morphologic LVNC population is strongly associated with adverse clinical events. LVNC is associated with increased trabeculations of the RV apex.
正常右心室 (RV) 小梁与异常小梁之间的区别一直难以界定。我们评估了 RV 容积和功能与左心室 (LV) 心肌致密化不全 (NC) 心肌病和临床事件的关系。通过心脏磁共振成像对 105 例连续病例进行了 RV 小梁或可能的 LVNC 的回顾性观察。我们测量了 LV 收缩末期 (ES) 非致密化与致密化比值、RV 射血分数 (EF)、RV 心尖小梁厚度和 RV 舒张末期 (ED) 非致密化与致密化比值。还对 40 例对照者进行了评估，以评估探索性措施。比较 LVES 非致密化与致密化比值≥2、LVES 非致密化与致密化比值<2 和正常对照组，得出 RV 心尖小梁厚度和 RVED 非致密化与致密化比值的调整平均值。使用逻辑回归评估与 LVNC 相关的复合事件与调整上述协变量、心血管危险因素、延迟增强、LVEF 和 LVES 非致密化与致密化比值后 RVEF 的相关性。对 RV 形态学的分析发现，与 LVES 非致密化与致密化比值<2 或正常对照组相比，LVES 非致密化与致密化比值≥2 的患者 RV 心尖小梁厚度更大（31 ± 5 比 27 ± 2.6 比 22 ± 4mm；p=0.03 和 p=0.003）。三组之间 RVED 非致密化与致密化比值无差异。在该人群中，即使在调整了临床和影像学参数后，低 RVEF 和 LVES 非致密化与致密化比值≥2 与临床事件仍有显著相关性（p=0.04 和 p<0.001）。总之，LVNC 形态人群中 RV 功能障碍与不良临床事件密切相关。LVNC 与 RV 心尖小梁增多有关。
