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P1441 Predictors of systemic embolisms in a large cohort of left ventricular noncompaction patients. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Left ventricular noncompaction (LVNC) is associated with an increased risk of systemic embolisms (SE). However, incidence and risk factors are not well established.
PURPOSE
To evaluate the rate of SE in LVNC and describe risk factors.
METHODS
LNVC patients were included in a multicentric registry. Those with SE were considered for the analysis.
RESULTS
514 patients with LVNC from 10 Spanish centres were recruited from 2000 to 2018. During a median follow-up of 4.2 years (IQR 1.9-7.1), 23 patients (4.5%) had a SE. Patients with SE (Table 1) were older at diagnosis, with no differences in gender and had similar cardiovascular risk factors. They were more frequently under oral anticoagulation (OAC). Besides, they had a more reduced LVEF, and more dilated LV and left atrium (LA). Late gadolinium enhancement (LGE) was more frequent, altogether suggesting a more severe phenotype.
Patients with SE had non-significantly higher rates of hospitalization for heart failure (33% Vs 24%, p = 0.31) and atrial fibrillation (35% Vs 19%, p = 0.10). In multivariate analysis, only LA diameter was an independent predictor of SE (OR 1.04, p = 0.04). A LA diameter > 45 mm had an independent 3 fold increased risk of SE (OR 3.04, p = 0.02) (Image 1).
CONCLUSIONS
LVNC carries a moderate mid-term risk of SE, which appears to be irrespective of atrial fibrillation and associated with age, LV dilatation and systolic dysfunction and mainly LA dilatation. This subgroup of patients should be considered for oral anticoagulation in primary prevention.
Table 1 Systemic embolisms (n = 23) No systemic embolisms (n = 491) p Men, n (%) 15 (65) 289 (56) 0.52 Median age at diagnosis (IQR) - yr 60 (48-76) 48 (30-64) 0.02 Median follow up (IQR) - yr 5.9 (3.1-7.8) 4.2 (1.8-7.1) 0.18 OAC, n (%) 19 (83) 118 (24) 0.01 LVEF (SD) - % 37 (15) 48 (17) 0.01 LVEDD (SD) - mm 58 (11) 54 (10) 0.04 LA diameter (SD) - mm 46 (9) 39 (9) 0.01 Characteristics of patients with and without systemic embolisms
Abstract P1441 Figure. Image 1
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P1442 Outcomes of patients with left ventricular noncompaction and preserved ejection fraction. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Left ventricular noncompaction (LVNC) has a wide phenotypic expression. Prognosis of patients with preserved ejection fraction (pEF) remains uncertain.
PURPOSE
To describe the characteristics and natural history of this subgroup of patients.
METHODS
LVNC patients were included in a multicentric registry. Those with pEF (LVEF > 50%) were considered for the analysis.
RESULTS
491 LVNC pts from 10 Spanish centres were recruited from 2000 to 2018. 239 (49%) had baseline pEF. Compared to those with reduced EF (rEF), they were younger, with no differences in gender and had less comorbilities (Table 1). Mean LVEF was 62% (SD 8). 18 pts (9% of the available CMR) had fibrosis even though LV volumes and LVEF were normal.
Family screening was completed in 199 pts, being positive in 113 (57%). Genetic testing was performed in 146 index cases, being positive in 80 (55%): ACTC1 (40), MYH7 (17), TTN (8), HCN4 (6) and other individual variants.
During a median follow-up of 4.9 years (IQR 2.1-7.3), there was a significant decrease in LVEF: last LVEF was 30- 40% in 5 pts (2%) and 40-50% in 21 (9%) (p = 0.01 compared to baseline LVEF). 6 pts (2.5%) died during follow-up, only 1 of cardiovascular cause. 9 patients (4%) presented heart failure (HF) and 25 (10.5%) ventricular tachycardia or fibrillation (VT/VF). All cardiovascular outcomes were less frequent compared to rEF (Image 1, all p < 0.05). In multivariate analysis (including demographic, imaging, genetic and family aggregation parameters) the only predictor for HF was change in LVEF (OR 0.89, mean LVEF at the event 47%, p = 0.01 compared to no HF). Fibrosis was not associated with VT/VF.
CONCLUSIONS
Patients with LVNC and pEF have an overall excellent prognosis, which is markedly better than those with rEF. However, there is progressive decrease in LVEF, associated with heart failure, and moderate risk of life threatening arrhythmias. Therefore, periodic follow-up should be promoted.
Table 1 LVNC pEF (n = 239) LVNC rEF (n = 252) p Men, n (%) 131 (55) 146 (58) 0.65 Median age at diagnosis (IQR) - yr 38 (23-54) 58 (42-72) 0.01 Median follow up (IQR) - yr 4.9 (2.1-7.3) 3.9 (1.4-7.9) 0.04 QRS (SD) - ms 93 (18) 117 (32) 0.01 LGE, n (%) 18 (9) 52 (30) 0.01
Abstract P1442 Figure. Image 1
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