Heart Vascular and Thoracic Institute Cleveland Clinic Cleveland OH.
Imaging InstituteCleveland Clinic Cleveland OH.
J Am Heart Assoc. 2021 Apr 20;10(8):e019209. doi: 10.1161/JAHA.120.019209. Epub 2021 Apr 9.
Background Left ventricular non-compaction remains a poorly described entity, which has led to challenges of overdiagnosis. We aimed to evaluate if the presence of a thin compacted myocardial layer portends poorer outcomes in individuals meeting cardiac magnetic resonance criteria for left ventricular non-compaction . Methods and Results This was an observational, retrospective cohort study involving individuals selected from the Cleveland Clinic Foundation cardiac magnetic resonance database (N=26 531). Between 2000 and 2018, 328 individuals ≥12 years, with left ventricular non-compaction or excessive trabeculations based on the cardiac magnetic resonance Petersen criteria were included. The cohort comprised 42% women, mean age 43 years. We assessed the predictive ability of myocardial thinning for the primary composite end point of major adverse cardiac events (composite of all-cause mortality, heart failure hospitalization, left ventricular assist device implantation/heart transplant, ventricular tachycardia, or ischemic stroke). At mean follow-up of 3.1 years, major adverse cardiac events occurred in 102 (31%) patients. After adjusting for comorbidities, the risk of major adverse cardiac events was nearly doubled in the presence of significant compacted myocardial thinning (hazard ratio [HR], 1.88 [95% CI, 1.18‒3.00]; =0.016), tripled in the presence of elevated plasma B-type natriuretic peptide (HR, 3.29 [95% CI, 1.52‒7.11]; =0.006), and increased by 5% for every 10-unit increase in left ventricular end-systolic volume (HR, 1.01 [95% CI, 1.00‒1.01]; =0.041). Conclusions The risk of adverse clinical events is increased in the presence of significant compacted myocardial thinning, an elevated B-type natriuretic peptide or increased left ventricular dimensions. The combination of these markers may enhance risk assessment to minimize left ventricular non-compaction overdiagnosis whilst facilitating appropriate diagnoses in those with true disease.
左心室心肌致密化不全仍是一种描述不足的病症，这导致了过度诊断的挑战。我们旨在评估在符合心脏磁共振左心室心肌致密化不全标准的个体中，存在薄的致密心肌层是否预示着更差的结局。
这是一项观察性、回顾性队列研究，涉及从克利夫兰诊所基金会心脏磁共振数据库中选择的个体（N=26531）。在 2000 年至 2018 年间，纳入了 328 名≥12 岁、根据心脏磁共振 Petersen 标准存在左心室心肌致密化不全或过度小梁化的个体。该队列包括 42%的女性，平均年龄 43 岁。我们评估了心肌变薄对主要不良心脏事件（全因死亡率、心力衰竭住院、左心室辅助装置植入/心脏移植、室性心动过速或缺血性卒中的复合终点）的预测能力。在平均 3.1 年的随访中，102 名（31%）患者发生了主要不良心脏事件。在调整了合并症后，在存在显著致密心肌变薄的情况下，主要不良心脏事件的风险几乎增加了一倍（风险比[HR]，1.88[95%置信区间，1.18-3.00]；=0.016），在存在升高的血浆 B 型利钠肽的情况下，风险增加了三倍（HR，3.29[95%置信区间，1.52-7.11]；=0.006），并且左心室收缩末期容积每增加 10 个单位，风险增加 5%（HR，1.01[95%置信区间，1.00-1.01]；=0.041）。
在存在显著致密心肌变薄、升高的 B 型利钠肽或增加的左心室尺寸的情况下，不良临床事件的风险增加。这些标志物的组合可能会增强风险评估，以最大限度地减少左心室心肌致密化不全的过度诊断，同时促进对真正疾病患者的适当诊断。
