Key result
Compact myocardial thickness <5 mm in ≥2 mid-ventricular segments accurately identifies reduced LVEF in isolated LVNC.
Why the study?
The Petersen index reflects myocardial trabeculation but is not specific for LVNC cardiomyopathy; the relation between compact layer thinning and systolic dysfunction in isolated LVNC was unclear.
Is thinning of the compact myocardial layer associated with reduced left ventricular ejection fraction in patients with isolated left ventricular non-compaction?
Case-Control (n=33)
Is thinning of the compact myocardial layer associated with reduced left ventricular ejection fraction in patients with isolated left ventricular non-compaction?
In patients with isolated left ventricular non-compaction, a thinned compact layer (<5 mm) in mid-ventricular segments of the LV free wall is strongly associated with reduced systolic function.
May aid risk stratification in isolated LVNC; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: The Petersen' index reflects an excess of myocardial trabeculation which is not a specific morpho-functional feature of left ventricular non-compaction (LVNC) cardiomyopathy, but a "phenotypic trait" even observed in association with other myocardial diseases and over-loading conditions. The present study was designed to evaluate the relation between a critical thinning of compact layer and the development of systolic dysfunction and LVNC cardiomyopathy. METHODS: We compared CMR morpho-functional features and measurements of LV wall thickness using a 17 segment model of a cohort of patients fulfilling the Petersen criterion for LVNC with LV systolic dysfunction versus those of a cohort of age- and sex-matched controls with LVNC and preserved LV systolic function. All the study patients had an "isolated" LVNC defined as positive Petersen criterion in the absence of other diseases such as hypertrophic and dilated cardiomyopathy, valvular heart disease, or congenital heart disease and over-loading conditions. RESULTS: he study population included 33 patients with "isolated" LVNC: 11 consecutive index patients with a reduced LV ejection fraction (LVNCrEF) and 22 controls with a preserved LVEF (LVNCpEF). The compact myocardial layer was thinner in patients with LVNCrEF than in those with LVNCpEF patients, both in mid-ventricular and apical LV segments. On linear regression analysis, there was a linear correlation between median thickness of mid-ventricular free wall segments and left ventricular ejection fraction (r = 0.51, p = 0.005). On the ROC curves analysis, ≥2 segments with a compact myocardial layer <5 mm in the free wall mid-ventricular segments showed the best accuracy for reduced LVEF (100% sensitivity and 60% specificity; AUC 0.81, p < 0.01). The negative predictive value for LV systolic dysfunction of <2 free wall mid ventricular segments <5 mm was 100%. On quantitative analysis, the mass of papillary muscles was lower in patients with LVNCrEF [1.2 (0.8-1.4) versus 1.6 (1.1-1.8) g/mq; p = 0.08]. CONCLUSIONS: A thinned compact layer of mid-ventricular segments of the LV free wall was associated with a reduced systolic function and "isolated" LVNC cardiomyopathy.
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Lazzari et al. (2023) conducted a case-control in Isolated left ventricular non-compaction (LVNC) (n=33). Thinning of compact layer vs. Preserved compact layer thickness was evaluated on Accuracy of ≥2 segments with a compact myocardial layer <5 mm in the free wall mid-ventricular segments for reduced LVEF (AUC 0.81, p=<0.01). Having ≥2 segments with a compact myocardial layer <5 mm in the free wall mid-ventricular segments accurately identified reduced left ventricular ejection fraction in isolated LVNC (AUC 0.81, p < 0.01).
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