Key result
Left ventricular myocardial crypts were not associated with major adverse cardiovascular events compared with no crypts (HR 1.00, 95% CI 0.72-1.40 for one crypt; HR 0.90, 95% CI 0.47-1.75 for multiple).
Why the study?
Left ventricular myocardial crypts are considered a subtle marker of hypertrophic cardiomyopathy but are also observed in healthy individuals, and whether they are associated with adverse outcomes was unknown.
Does the presence of left ventricular myocardial crypts increase the risk of major adverse cardiovascular events in the general population?
Cohort (n=10,097)
Does the presence of left ventricular myocardial crypts increase the risk of major adverse cardiovascular events in the general population?
Hazard Ratio: 1 (95% CI 0.72–1.4)
p-value: p=0.98
Left ventricular myocardial crypts are common in the general population and are not associated with an increased risk of intermediate-term major adverse cardiovascular events.
Myocardial crypts warrant no clinical concern in the general population; extends benign prognosis data but leaves causality in HCM open.
AIMS: Left ventricular (LV) myocardial crypts are considered a subtle marker of hypertrophic cardiomyopathy. However, crypts have also been observed in seemingly healthy individuals and it is unknown whether myocardial crypts are associated with adverse outcome. METHODS AND RESULTS: Myocardial crypts were defined as invaginations traversing >50% of the myocardial wall and assessed using contrast-enhanced cardiac computed tomography in 10 097 individuals from the Copenhagen General Population Study. Number of crypts, location, shape, penetrance, and volume were assessed. The endpoint was a composite of major adverse cardiovascular events and defined as death, myocardial infarction, heart failure, or stroke. Cox regression models were adjusted for clinical variables, medical history, electrocardiographic parameters, and cardiac chamber sizes. A total of 1199 LV myocardial crypts were identified in 915 (9.1%) individuals. Seven hundred (6.9%) had one crypt and 215 (2.1%) had multiple crypts. During a median follow-up of 4.0 years (interquartile range 1.5-6.7), major adverse cardiovascular events occurred in 619 individuals. Individuals with one or multiple crypts had a hazard ratio for major adverse cardiovascular events of 1.00 [95% confidence interval (CI): 0.72-1.40; P = 0.98] and 0.90 (95% CI: 0.47-1.75; P = 0.76), respectively, compared with those with no crypts. No specific pattern of crypt location, shape, penetrance, or volume was associated to an increased hazard ratio for major adverse cardiovascular events. CONCLUSION: LV myocardial crypts are frequent in the general population and are not associated with intermediate-term major adverse cardiovascular events.
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Sigvardsen et al. (2020) conducted a cohort in General population (n=10,097). Left ventricular myocardial crypts vs. No crypts was evaluated on Composite of major adverse cardiovascular events (death, myocardial infarction, heart failure, or stroke) (HR 1.00, 95% CI 0.72-1.40, p=0.98). Left ventricular myocardial crypts were not associated with major adverse cardiovascular events compared with no crypts (HR 1.00, 95% CI 0.72-1.40 for one crypt; HR 0.90, 95% CI 0.47-1.75 for multiple).
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