Left Ventricular Hypertrabeculation and Prognosis in Dilated Cardiomyopathy

BACKGROUND: Left ventricular (LV) hypertrabeculation, formerly termed LV noncompaction, is a heterogeneous myocardial entity linked to adverse cardiovascular outcomes. This study evaluated embolic risk in patients with dilated cardiomyopathy (DCM) according to the presence of hypertrabeculation and examined its prevalence and prognostic relevance across DCM genotypes. METHODS: Clinical data from 1160 patients with DCM evaluated by cardiac magnetic resonance imaging and genetic testing (n=997 [86%]) were collected from 22 international centers. End points included embolic events, advanced heart failure events, and major ventricular arrhythmias. RESULTS: LV hypertrabeculation was identified in 354 patients (30.5%) by fractal analysis and in 343 (29.7%) according to Petersen criteria, with good concordance. After a median follow-up of 5.1 years (interquartile range, 2.8–7.4), embolic events occurred in 37 patients (3.2%), advanced heart failure in 62 (5.3%), and major ventricular arrhythmias in 136 (11.7%). Hypertrabeculation was not associated with increased embolic risk (hazard ratio, 1.5 [95% CI, 0.75–3.00]), even among patients in sinus rhythm with LV ejection fraction ≤40% (hazard ratio, 1.89 [95% CI, 0.7–5.5]). In contrast, atrial fibrillation and reduced LV ejection fraction were associated with embolic events (both P <0.01). LV hypertrabeculation was not associated with an increased risk of major ventricular arrhythmias or advanced heart failure; genotype, LV ejection fraction, and late gadolinium enhancement emerged as the main predictors of adverse outcomes. The prevalence of LV hypertrabeculation varied across genotypes, with the highest prevalence observed in patients with sequence variants in motor sarcomeric genes (58%), TTN (38%), and genotype-negative status (33%), and the lowest prevalence observed among those with variants in cytoskeletal/Z-disk (7%) and nuclear envelope (5%) genes. Hypertrabeculation was not associated with adverse outcomes within any genotype. CONCLUSIONS: Although LV hypertrabeculation is common in DCM, it is not associated with worse outcomes and should not prompt differential clinical management. The embolic risk in patients with DCM and hypertrabeculation is low, including in those with reduced LV ejection fraction without atrial fibrillation, and does not support prophylactic anticoagulation in these patients.

Authors

Institutions

Publication Details

Journal
Circulation
Published
2026-08-03
DOI
https://doi.org/10.1161/circulationaha.125.078536
Primary Topic
Cardiomyopathy and Myosin Studies
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Left Ventricular Hypertrabeculation and Prognosis in Dilated Cardiomyopathy

Guillem Casas, Roberto Barriales‐Villa, Nerea Mora Ayestarán, Esther Zorio et al.
Circulation
Cardiomyopathy and Myosin Studies
article

Left Ventricular Hypertrabeculation and Prognosis in Dilated Cardiomyopathy

Guillem Casas, Roberto Barriales‐Villa, Nerea Mora Ayestarán, Esther Zorio, Ramón Brugada, Connie R. Bezzina, Antoni Bayés‐Genís, Ana García‐Álvarez, María Gallego‐Delgado, Francisco Bermúdez-Jiménez, Marı́a Brión, Marina Navarro Peñalver, José Manuel García‐Pinilla, Gonzalo Cabezón Villalba, Eduardo Villacorta, Edwin Poel, María Ángeles Espinosa, José M. Larrañaga‐Moreira, Ahmad S. Amin, Elena Rodríguez‐González, Rafael Salguero‐Bodes, Eduard Claver-Garrido, Ana Royuela, Pablo García‐Pavía, Noemí Ramos, María Sabater‐Molina, Javier Limeres Freire, Vicente Climent, María Teresa Basurte-Elorz, María V. Mogollón, Andrea Di Marco, Carles Díez‐López, Cristina Gómez‐González, Tomás Ripoll‐Vera, María Luisa Peña‐Peña, Gemma Lacuey, Juan Pablo Ochoa, Miriam Sánchez, Jesus G. Mirelis, José F. Rodríguez-Palomares, Amaia Yuan Ibargoyen
article en

Abstract

BACKGROUND: Left ventricular (LV) hypertrabeculation, formerly termed LV noncompaction, is a heterogeneous myocardial entity linked to adverse cardiovascular outcomes. This study evaluated embolic risk in patients with dilated cardiomyopathy (DCM) according to the presence of hypertrabeculation and examined its prevalence and prognostic relevance across DCM genotypes. METHODS: Clinical data from 1160 patients with DCM evaluated by cardiac magnetic resonance imaging and genetic testing (n=997 [86%]) were collected from 22 international centers. End points included embolic events, advanced heart failure events, and major ventricular arrhythmias. RESULTS: LV hypertrabeculation was identified in 354 patients (30.5%) by fractal analysis and in 343 (29.7%) according to Petersen criteria, with good concordance. After a median follow-up of 5.1 years (interquartile range, 2.8–7.4), embolic events occurred in 37 patients (3.2%), advanced heart failure in 62 (5.3%), and major ventricular arrhythmias in 136 (11.7%). Hypertrabeculation was not associated with increased embolic risk (hazard ratio, 1.5 [95% CI, 0.75–3.00]), even among patients in sinus rhythm with LV ejection fraction ≤40% (hazard ratio, 1.89 [95% CI, 0.7–5.5]). In contrast, atrial fibrillation and reduced LV ejection fraction were associated with embolic events (both P <0.01). LV hypertrabeculation was not associated with an increased risk of major ventricular arrhythmias or advanced heart failure; genotype, LV ejection fraction, and late gadolinium enhancement emerged as the main predictors of adverse outcomes. The prevalence of LV hypertrabeculation varied across genotypes, with the highest prevalence observed in patients with sequence variants in motor sarcomeric genes (58%), TTN (38%), and genotype-negative status (33%), and the lowest prevalence observed among those with variants in cytoskeletal/Z-disk (7%) and nuclear envelope (5%) genes. Hypertrabeculation was not associated with adverse outcomes within any genotype. CONCLUSIONS: Although LV hypertrabeculation is common in DCM, it is not associated with worse outcomes and should not prompt differential clinical management. The embolic risk in patients with DCM and hypertrabeculation is low, including in those with reduced LV ejection fraction without atrial fibrillation, and does not support prophylactic anticoagulation in these patients.

CirculationVol. 154(5)
Universidad Complutense de Madrid (ES), Universitat Autònoma de Barcelona (ES), University of Alicante (ES), Dr. M.G.R. Educational and Research Institute (IN), Universidad Francisco de Vitoria (ES), Hospital General Universitario Gregorio Marañón (ES), Hospital Universitari i Politècnic La Fe (ES), Research Institute Hospital 12 de Octubre (ES), Institut d'Investigació Biomédica de Bellvitge (ES), Hospital Son Llatzer (ES), Instituto de Estudios de Ciencias de la Salud de Castilla y León (ES), Complejo Hospitalario Universitario de Santiago (ES), Complejo Hospitalario de Salamanca (ES), Hospital Universitario 12 De Octubre (ES), Vall d'Hebron Institut de Recerca (ES), Hospital Universitario Puerta de Hierro Majadahonda (ES), Navarre Institute of Health Research (ES), Institut d'Investigació Biomèdica de Girona (ES), Instituto de Investigación Biosanitaria de Granada (ES), Hospital Universitario Virgen de las Nieves (ES), Hospital Santa Caterina (ES), Vall d'Hebron Hospital Universitari (ES), Spanish National Centre for Cardiovascular Research (ES), Instituto de Investigación Biomédica de Salamanca (ES), Hospital General Universitario de Alicante Doctor Balmis (ES), Complexo Hospitalario Universitario A Coruña (ES), Instituto de Biomedicina y Genética Molecular de Valladolid (ES), ERN GUARD-Heart (NL), Instituto de Investigación Sanitaria de Santiago (ES), Hospital Universitario Virgen de la Arrixaca (ES), Amsterdam University Medical Centers (NL), Hospital Universitario Virgen del Rocío (ES), Hospital Universitari Germans Trias i Pujol (ES), Hospital Universitari de Girona Doctor Josep Trueta (ES), Hospital Clínico Universitario Virgen de la Victoria (ES), Hospital Clínico Universitario de Valladolid (ES), Complejo Hospitalario de Cáceres (ES), Instituto de Investigación Biomédica de A Coruña (ES), Consorci Institut D'Investigacions Biomediques August Pi I Sunyer (ES), Instituto de Investigación Sanitaria La Fe (ES), Universidad de Málaga (ES), Universidad de Navarra (ES)
Good health and well-being
Openalex Percentile: Top 9%
Cardiomyopathy and Myosin Studies
DOISourceOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.