Key result
Frequent PVCs, non-sustained VT, low QRS voltage, and systolic dysfunction predict life-threatening events in LVNC.
Why the study?
LVNC is a genetic cardiomyopathy manifesting as arrhythmias, heart failure, and thrombus formation, prompting the need to identify predictors of arrhythmic, thromboembolic events, and adverse outcomes.
Frequent PVCs, non-sustained VT, low QRS voltage, and signs of systolic dysfunction on echocardiogram predict life-threatening events in adult patients with left ventricular noncompaction.
May refine arrhythmic risk assessment in LVNC; extends prior observations but leaves open prospective validation.
BACKGROUND Left ventricular noncompaction (LVNC) is a genetic cardiomyopathy. It is characterized by intensely developed trabeculae in the ventricles with deep intertrabecular lacunae. LVNC manifests as arrhythmias and heart failure with a predisposition for thrombus formation. AIM To study predictors of arrhythmic, thromboembolic events and adverse outcomes (death/transplantation) in adult patients with LVNC. METHODS Adult patients with LVNC were included (n = 125; mean follow-up: 14 months). Electrocardiography, echocardiography, and 24-hour electrocardiography monitoring were performed. Other procedures were conducted for some patients including: Coronary angiography; cardiac magnetic resonance imaging; cardiac computed tomography; genetic testing; myocardial pathological examination; and anti-cardiac antibody level estimation. Primary endpoints were death, heart transplantation, combined endpoint (death + transplantation), and sudden cardiac death. Secondary endpoints were intracardiac thrombosis, embolic events, myocardial infarction, sustained ventricular tachycardia (VT), and implantable cardioverter-defibrillator intervention. RESULTS LVNC manifestations included non-sustained VT, thrombosis/embolism, sustained VT, and sudden cardiac death. Non-sustained VT was associated with the New York Heart Association (NYHA) chronic heart failure (CHF) class, poor R-wave progression, superimposed myocarditis, and higher mortality. Thrombosis/embolism was associated with NYHA CHF class ≥ 3, right ventricular end-diastolic diameter ≥ 3 cm, right atrium volume ≥ 67 mL, left ventricle end-diastolic diameter ≥ 6.3 cm, and velocity time integral ≤ 11.2 cm. Sustained VT was associated with premature ventricular contractions (PVCs), low QRS voltage, and atrioventricular block. PVCs > 500/day were predictive of defibrillator intervention. Fatal outcomes were associated with E wave/A wave ratio > 1.9, left ventricle ejection fraction < 35%, NYHA CHF class ≥ 3, VT, and myocarditis. CONCLUSION Frequent PVCs, non-sustained VT, low QRS voltage, and signs of systolic dysfunction on echocardiogram are predictors of life-threatening events in patients with LVNC.
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Blagova et al. (2025) studied this question. Frequent PVCs, non-sustained VT, low QRS voltage, and systolic dysfunction indicators are predictors of life-threatening events in LVNC patients.
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