Men with LVNC had a higher prevalence of major adverse cardiovascular events (67% vs. 33%, p=0.024) and worse outcomes including mortality and heart failure hospitalization over 7 years.
Does male sex increase the risk of major adverse cardiovascular events in adult patients with left ventricular noncompaction?
Male sex is associated with a significantly higher risk of major adverse cardiovascular events in patients with left ventricular noncompaction compared to females.
Abstract Introduction Left ventricular noncompaction (LVNC) is characterized by numerous prominent trabeculations and deep intertrabecular recesses connected to the left ventricular cavity. It can exist in isolation or in combination with other congenital heart diseases. Patients with LVNC are at risk of heart failure (HF), ventricular arrhythmias, sudden cardiac death, and thromboembolic events. However, sex differences in the prevalence and predictors of major adverse cardiovascular events (MACE) in LVNC remain unclear. Purpose This multicenter study aimed to investigate sex-based differences in outcomes among patients with LVNC. Methods 214 adult patients (54% male, mean age 41±16 years) meeting the imaging-cardiac magnetic resonance (CMR) criteria for LVNC were identified (Fig 1). The primary endpoint was a composite of all-cause mortality, HF hospitalization, need for a left ventricular assist device (LVAD) or heart transplant, cardiac resynchronization therapy (CRT), CVA/transient ischemic attacks (TIA), and VT/appropriate implantable cardioverter defibrillator (ICD) therapy. Results Baseline clinical and imaging characteristics were comparable in men and women LVNC patients; however, women had a higher prevalence of CVA/TIA and thinner compacted myocardial layer than men. Men had higher LV end-systolic (LVESV) and end-diastolic (LVEDV) indexed volumes. Over a median follow-up time of 7 years (IQR, 4–10 years), 54 patients (24%) experienced a primary outcome. Overall prevalence of MACE was higher in men compared to women (n=36 (67%) vs. n=18 (33%); p=0.024). Men had a significantly higher prevalence of all-cause mortality and HF hospitalization/CRT. The prevalence of CVA/TIA, VT/ appropriate ICD therapy, and LVAD/heart transplant was similar between the sexes (Fig 2, A). Men with LVNC experienced more cumulative adverse events than women (chi-square = 4.522, log-rank =0.033) (Fig 2, B). Univariate Cox regression analysis identified VT, left bundle branch block (LBBB), left ventricular volume index (LVESVi), and late gadolinium enhancement (LGE) as predictors of adverse outcomes in both groups. The LVESVi cut-off values for predicting outcomes differed between men and women (Fig 2, C, D). In multivariate analysis, LBBB remained significantly associated with MACE in both sexes. Conclusions Male sex is associated with worse cardiovascular outcomes in LVNC patients. While clinical and imaging predictors of MACE are similar between men and women, sex-specific cut-off values in imaging characteristics for the prediction of events may differ. Recognizing these differences could help refine risk stratification and targeted treatment strategies for LVNC patients.LVNC in man and woman, CMR images MACE and imaging predictors in LVNC
Gegenava et al. (2025) studied this question. Men with LVNC had a higher prevalence of major adverse cardiovascular events (67% vs. 33%, p=0.024) and worse outcomes including mortality and heart failure hospitalization over 7 years.