Increased Left Ventricular Trabeculation Is Associated With Increased B-Type Natriuretic Peptide Levels and Impaired Outcomes in Nonischemic Cardiomyopathy

The clinical significance of left ventricular (LV) trabeculation remains unknown in cardiomyopathies. B-Type natriuretic peptide (BNP) strongly reflects LV end-diastolic wall stress and is a useful prognostic marker of cardiovascular diseases. The enhanced identification of LV trabeculae (T) with the use of cardiac magnetic resonance and the evaluation of its relationship with BNP may elucidate the biologic significance and clinical impact of trabeculation in patients with nonischemic cardiomyopathy (NICM). The LV volume and mass of 515 patients with NICM and 36 control subjects were analyzed with the use of a steady-state free precession sequence, and individual T mass was planimetred. Major adverse cardiac events (MACE) were assessed. T mass index correlated with LV end-diastolic volume index (EDVI), LV mass index, and papillary muscle mass index (all P < 0.001). Also, T mass index was positively correlated with BNP level (R = 0.381; P < 0.001) and was an independent determinant of BNP after adjusting for age, sex, body mass index (BMI), etiology, LV ejection fraction, and LV EDVI (P < 0.001). Kaplan-Meier analysis during a median follow-up of 17.3 months showed that higher T mass index and increased BNP level correlated with MACE. On multivariate analysis, T mass index (P = 0.031) and BNP (P < 0.001) remained associated with poor outcomes when combined with age, sex, BMI, and etiology. Increased LV trabeculation was associated with LV dysfunction/remodelling and impaired outcomes in NICM of various etiologies. This may support the biologic significance of LV trabeculation and could be attributed to its association with BNP through LV wall stress. La portée clinique de la trabéculation ventriculaire gauche (VG) chez les patients atteints d’une cardiomyopathie demeure inconnue. Le peptide natriurétique de type B (BNP) est un marqueur important du stress que subit la paroi VG en fin de diastole et est utile pour établir un pronostic chez les patients atteints d’une maladie cardiovasculaire. L’amélioration de la détection des trabécules VG grâce à la résonance magnétique cardiaque et l’évaluation de leur relation avec le taux de BNP pourrait permettre d’élucider la signification biologique et la portée clinique de la trabéculation chez les patients atteints d’une cardiomyopathie non ischémique. Le volume et la masse VG de 515 patients atteints d’une cardiomyopathie non ischémique et de 36 sujets témoins ont été analysés au moyen d’une séquence de précession