What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Left ventricular noncompaction (LVNC) (n=2501). Intervention: Left ventricular noncompaction (LVNC) vs. Dilated cardiomyopathy (DCM). Primary outcome: Cardiovascular mortality (OR 1.10, 95% CI 0.18-6.67).

January 1, 2020Open Access

Prognostic Significance of Left Ventricular Noncompaction

Key Result

Left ventricular noncompaction was associated with a cardiovascular mortality rate of 1.92 per 100 person-years, which was similar to the risk observed in patients with dilated cardiomyopathy (OR 1.10).

Study Design

Type

Meta-Analysis (n=2,501)

Structured PICO

Does left ventricular noncompaction increase the risk of cardiovascular mortality compared to dilated cardiomyopathy?

Population

28 observational studies enrolling 2501 patients with left ventricular noncompaction (LVNC), mean age 46 years, male/female ratio 1.7.

Intervention

Left ventricular noncompaction (exposure)

Comparator

Dilated cardiomyopathy control group

Outcome

Cardiovascular mortalityhard clinical

Patients with left ventricular noncompaction have a similar cardiovascular risk profile to those with dilated cardiomyopathy, and outcomes are primarily driven by left ventricular ejection fraction rather than the extent of trabeculation.

Main Result

Effect estimate: OR 1.10 (95% CI 0.18-6.67)

Limitations

Relied on observational, mostly single-center, cohort studies with variable methodological quality
Only focused on the adult population mostly free from congenital heart disease
Comparison of the rates of incident cardiovascular events between LVNC and hypertrophic cardiomyopathy was not performed
Meta-regression analyses were limited to the studies without missing covariate information
Only a few studies reported the incidence rates in a comparable DCM cohort
Incidence rates of adverse events observed only hold true for an intermediate follow-up duration

Abstract

BACKGROUND: Although left ventricular noncompaction (LVNC) has been associated with an increased risk of adverse cardiovascular events, the accurate incidence of cardiovascular morbidity and mortality is unknown. We, therefore, aimed to assess the incidence rate of LVNC-related cardiovascular events. METHODS: We systematically searched observational studies reporting the adverse outcomes related to LVNC. The primary end point was cardiovascular mortality. RESULTS: We identified 28 eligible studies enrolling 2501 LVNC patients (mean age, 46 years; male/female ratio, 1.7). After a median follow-up of 2.9 years, the pooled event rate for cardiovascular mortality was 1.92 (95% CI, 1.54-2.30) per 100 person-years. LVNC patients had a similar risk of cardiovascular mortality compared with a dilated cardiomyopathy control group (odds ratio, 1.10 95% CI, 0.18-6.67). The incidence rates of all-cause mortality, stroke and systemic emboli, heart failure admission, cardiac transplantation, ventricular arrhythmias, and cardiac device implantation were 2.16, 1.54, 3.53, 1.24, 2.17, and 2.66, respectively, per 100 person-years. Meta-regression and subgroup analyses revealed that left ventricular ejection fraction, not the extent of left ventricular trabeculation, had an important influence on the variability of incidence rates. The risks of thromboembolism and ventricular arrhythmias in LVNC patients were similar to dilated cardiomyopathy patients. However, LVNC patients had a higher incidence of heart failure hospitalization than dilated cardiomyopathy patients. CONCLUSIONS: Patients with LVNC carry a similar cardiovascular risk when compared with dilated cardiomyopathy patients. Left ventricular ejection fraction-a conventional indicator of heart failure severity, not the extent of trabeculation-appears to be an important determinant of adverse outcomes in LVNC patients. Registration: https://www.crd.york.ac.uk/PROSPERO/ Unique identifier: CRD42018096313.

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