Usefulness of Neuromuscular Co-morbidity, Left Bundle Branch Block, and Atrial Fibrillation to Predict the Long-Term Prognosis of Left Ventricular Hypertrabeculation/Noncompaction

Am J Cardiol. 2020 Aug 1;128:168-173. doi: 10.1016/j.amjcard.2020.04.040. Epub 2020 May 13.

Abstract

The prognosis of patients with left ventricular hypertrabeculation/noncompaction (LVHT) is assessed controversially. LVHT is associated with other cardiac abnormalities and with neuromuscular disorders (NMD). Aim of the study was to assess cardiac and neurological findings as predictors of mortality rate in adult LVHT-patients. Included were patients with LVHT diagnosed between 1995 and 2019 in 1 echocardiographic laboratory. Patients underwent a baseline cardiologic examination and were invited for a neurological investigation. In January 2020, their survival status was assessed. End points were death or heart transplantation. LVHT was diagnosed by echocardiography in 310 patients (93 female, aged 53 ± 18 years) with a prevalence of 0.4%/year. A neurologic investigation was performed in 205 patients (67%). A specific NMD was found in 33 (16%), NMD of unknown etiology in 123 (60%) and the neurological investigation was normal in 49 (24%) patients. During follow-up of 84 ± 71 months, 59 patients received electronic devices, 105 patients died, and 6 underwent heart transplantation. The mortality was 4.7%/year, the rate of heart transplantation/death 5%/year. By multivariate analysis, the following parameters were identified to elevate the risk of mortality/heart transplantation: increased age (p = 0.005), inpatient (p = 0.001), presence of a specific NMD (p = 0.0312) or NMD of unknown etiology (p = 0.0365), atrial fibrillation (p = 0.0000), ventricular premature complexes (p = 0.0053), exertional dyspnea (p = 0.0023), left bundle branch block (p = 0.0201), and LVHT of the posterior wall (p = 0.0158). In conclusion, LVHT patients should be systematically investigated neurologically since neurological co-morbidity has a prognostic impact.

MeSH terms

  • Adult
  • Aged
  • Atrial Fibrillation / epidemiology*
  • Bundle-Branch Block / epidemiology*
  • Comorbidity
  • Echocardiography
  • Echocardiography, Doppler
  • Female
  • Heart Transplantation / statistics & numerical data*
  • Humans
  • Isolated Noncompaction of the Ventricular Myocardium / epidemiology*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Mortality*
  • Muscular Diseases / epidemiology
  • Muscular Dystrophy, Duchenne / epidemiology
  • Myotonic Dystrophy / epidemiology
  • Neuromuscular Diseases / epidemiology*
  • Optic Atrophy, Hereditary, Leber / epidemiology
  • Postpoliomyelitis Syndrome / epidemiology
  • Prognosis
  • Proportional Hazards Models