A study from the Puerta de Hierro Hospital in Majadahonda concludes that left ventricular hypertrabeculation does not worsen prognosis in patients with dilated cardiomyopathy.
The Puerta de Hierro University Hospital in Majadahonda has led the largest study conducted to date on left ventricular hypertrabeculation, an anatomical feature of the heart that has been associated with a worse prognosis for years. The results, published in the journal Circulation, indicate that this condition does not imply a more unfavourable clinical evolution in patients with dilated cardiomyopathy.
The research, coordinated by Dr. Pablo García-Pavía, head of the Familial Heart Disease Unit at the centre and of the hereditary cardiomyopathies group at the CNIC, analysed 1,160 patients from 22 centres in Spain and the Netherlands. After an average follow-up of more than five years, the researchers found that the presence of hypertrabeculation is not associated with a higher risk of embolic events, advanced heart failure, or severe ventricular arrhythmias.
Hypertrabeculation is characterised by an increase in the number or thickness of trabeculae, small muscular structures that line the inner surface of the left ventricle. For years, it was considered an independent disease, called non-compacted cardiomyopathy, and more aggressive treatments, such as preventive anticoagulation to avoid thrombi, were recommended. This new work resolves the controversy: it is a morphological trait within dilated cardiomyopathy, not a separate clinical entity.
“The true factors associated with prognosis were already known variables, such as the ventricular ejection fraction, the presence of cardiac fibrosis detected by magnetic resonance imaging, or certain genetic alterations,” explains García-Pavía. The study also reveals that hypertrabeculation does not increase the risk of cerebral or systemic embolisms, even in patients with reduced cardiac function and without atrial fibrillation.
Dr. Nerea Mora, a cardiologist at Puerta de Hierro and the first author of the work, emphasises that this result “questions the need to use preventive anticoagulation solely due to the presence of hypertrabeculation.” Furthermore, genetic analysis showed that, although the frequency of this feature varies according to the genetic cause of the disease, “its presence did not modify the clinical risk within any of the analysed genetic groups.”
For patients in the Community of Madrid, this finding represents a change in clinical approach: it avoids unnecessary treatments and allows for focusing follow-up on real prognostic markers. The work has been funded by the Carlos III Health Institute, with FEDER funds and the Horizon Europe programme.
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