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Meta-Analysis
. 2020 Jan;13(1):e009712.
doi: 10.1161/CIRCIMAGING.119.009712. Epub 2020 Jan 21.

Prognostic Significance of Left Ventricular Noncompaction: Systematic Review and Meta-Analysis of Observational Studies

Nay Aung  1   2 , Sara Doimo  3 , Fabrizio Ricci  4 , Mihir M Sanghvi  1   2 , Cesar Pedrosa  1 , Simon P Woodbridge  1 , Amer Al-Balah  5 , Filip Zemrak  1   2 , Mohammed Y Khanji  1   2 , Patricia B Munroe  1   2   6 , Huseyin Naci  7 , Steffen E Petersen  1   2
Affiliations
Meta-Analysis

Prognostic Significance of Left Ventricular Noncompaction: Systematic Review and Meta-Analysis of Observational Studies

Nay Aung et al. Circ Cardiovasc Imaging. 2020 Jan.

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.

Keywords: cardiac imaging techniques; cardiomyopathies; meta-analysis; prognosis.

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Figures

Figure 1.
Figure 1.
Genotype and phenotype of LVNC. A, Venn diagram of the number of genes associated with inherited cardiomyopathy; (B) cardiovascular magnetic resonance images demonstrating a classic left ventricular noncompaction (LVNC) with a 2-layer appearance of thin compact myocardium and excessive trabeculation (top left), isolated LVNC with normal chamber size and function (top right), mixed dilated cardiomyopathy (DCM) and LVNC with biventricular involvement (bottom left), and hypertrophic cardiomyopathy (HCM) with features of LVNC (bottom right). ARVC indicates arrhythmogenic right ventricular cardiomyopathy.
Figure 2.
Figure 2.
Flowchart demonstrating the process of study selection.
Figure 3.
Figure 3.
Distribution of study quality according to Quality in Prognosis Studies tool.
Figure 4.
Figure 4.
Forest plot demonstrating the individual and overall incidences of cardiovascular deaths per 100 person-years. The vertical dotted line indicates the pooled average incidence rate.
Figure 5.
Figure 5.
Funnel plot for cardiovascular (CV) mortality. The red dots represent the original studies included in the meta-analysis while the blue dots represent the missing studies imputed by the trim-and-fill method. The vertical dashed line indicates the original pooled incidence rates, and the vertical solid line indicates the revised pool incidence rates after inclusion of the imputed missing studies to counter publication bias.
Figure 6.
Figure 6.
Subgroup analyses for cardiovascular mortality. A Incidence of cardiovascular mortality in subgroups stratified by person-years >300; (B) incidence of cardiovascular mortality in subgroups stratified by left ventricular ejection fraction (LVEF) <45%; (C) incidence of cardiovascular mortality in subgroups stratified by high vs low-moderate risk of bias; (D) incidence of cardiovascular mortality in left ventricular noncompaction (LVNC) meta-analysis vs external dilated cardiomyopathy (DCM) meta-analysis. The vertical dotted line indicates the pooled average incidence rate.
Figure 7.
Figure 7.
Forest plot of cardiovascular mortality in left ventricular noncompaction (LVNC) patients compared with dilated cardiomyopathy (DCM) controls. The vertical dotted line represents the pooled odds ratio.
See this image and copyright information in PMC

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References

    1. Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, Moss AJ, Seidman CE, Young JB American Heart Association. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation. 2006;113:1807–1816. doi: 10.1161/CIRCULATIONAHA.106.174287. - PubMed
    1. Elliott P, Andersson B, Arbustini E, Bilinska Z, Cecchi F, Charron P, Dubourg O, Kühl U, Maisch B, McKenna WJ, et al. Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2008;29:270–276. doi: 10.1093/eurheartj/ehm342. - PubMed
    1. Arbustini E, Weidemann F, Hall JL. Left Ventricular Noncompaction: A Distinct Cardiomyopathy or a Trait Shared by Different Cardiac Diseases? J Am Coll Cardiol. 2014;64:1840–1850. doi: 10.1016/j.jacc.2014.08.030. - PMC - PubMed
    1. Gati S, Chandra N, Bennett RL, Reed M, Kervio G, Panoulas VF, Ghani S, Sheikh N, Zaidi A, Wilson M, et al. Increased left ventricular trabeculation in highly trained athletes: do we need more stringent criteria for the diagnosis of left ventricular non-compaction in athletes? Heart Br Card Soc. 2013;99:401–408. doi: 10.1136/heartjnl-2012-303418. - PubMed
    1. Gati S, Papadakis M, Van Niekerk N, Reed M, Yeghen T, Sharma S. Increased left ventricular trabeculation in individuals with sickle cell anaemia: physiology or pathology? Int J Cardiol. 2013;168:1658–1660. doi: 10.1016/j.ijcard.2013.03.039. - PubMed

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