Left Ventricular Trabeculation: Arrhythmogenic and Clinical Significance in Elite Athletes - 03/06/24

Doi : 10.1016/j.echo.2024.03.003

Giuseppe Di Gioia, MD ^a,^b,^c,^⁎ , Simone Pasquale Crispino, MD ^b, Sara Monosilio, MD ^a,^d, Viviana Maestrini, MD, PhD ^a,^d, Antonio Nenna, MD, PhD ^e, Alessandro Spinelli, MD ^a, Erika Lemme, MD ^a, Maria Rosaria Squeo, MD ^a, Antonio Pelliccia, MD ^a
^a Institute of Sports Medicine and Science, National Italian Olympic Committee, Rome, Italy
^b Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
^c Department of Movement, Human and Health Sciences, University of Rome “Foro Italico,” Rome, Italy
^d Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
^e Department of Heart Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy

^∗Reprint requests: Giuseppe Di Gioia, MD, Via Francesco Bartolomeo Rastrelli, 90-00128, Rome, Italy.Via Francesco Bartolomeo RastrelliRome90-00128Italy

Abstract

Introduction

Left ventricular (LV) trabeculations (LVTs) are common findings in athletes. Limited information exists regarding clinical significance, management, and outcome.

Objectives

The purpose of this study is to examine the prevalence and morphologic characteristics of LVTs in elite athletes, with a focus on clinical correlates and prognostic significance.

Methods

We enrolled 1,492 Olympic elite athletes of different sports disciplines with electrocardiogram, echocardiogram, and exercise stress test. Individuals with a definite diagnosis of LV noncompaction (LVNC) were excluded; we focused on athletes with LVTs not meeting the criteria for LVNC.

Results

Four hundred thirty-five (29.1%) athletes presented with LVTs, which were more frequent in male athletes (62.1% vs 53.5%, P = .002) and Black athletes compared with Caucasian (7.1% vs 2.4%, P < .0001) and endurance athletes (P = .0005). No differences were found with relation to either the site or extent of trabeculations. Endurance athletes showed a higher proportion of LVTs and larger LV volumes (end-diastolic and end-systolic, respectively, 91.5 ± 19.8 mL vs 79.3 ± 29.9 mL, P = .002; and 33.1 ± 10 mL vs 28.6 ± 11.7 mL, P = .007) and diastolic pattern with higher E wave (P = .01) and e’ septal velocities (P = .02). Ventricular arrhythmias were found in 14% of LVTs versus 11.6% of athletes without LVTs (P = .22). Neither the location nor the LVTs’ extension were correlated to ventricular arrhythmias. At 52 ± 32 months of follow-up, no differences in arrhythmic burden were observed (11.1% in LVT athletes vs 10.2%, P = .51).

Conclusions

Left ventricular trabeculations are quite common in athletes, mostly male, Black, and endurance, likely as the expression of adaptive remodeling. In the absence of associated clinical abnormalities, such as LV systolic and diastolic impairment, electrocardiogram repolarization abnormalities, or family evidence of cardiomyopathy, athletes with LVTs have benign clinical significance and should not require further investigation.

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Central Illustration

Clinical (panel 1), functional (panel 2), and morphologic (panel 3) characteristics of LVTs in Olympic athletes. Panel 3 shows the distribution of LVTs according to their localization in anterior, lateral, inferior, and septal and involvement of basal, medium, or apical portion. According to results, LVTs can be considered as a benign condition, not requiring further investigations in most cases. ANT, Anterior; API, apical; BAS, basal; INF, inferior; MED, medium; LAT, lateral; SEP, septal.

Central Illustration :

Central IllustrationClinical (panel 1), functional (panel 2), and morphologic (panel 3) characteristics of LVTs in Olympic athletes. Panel 3 shows the distribution of LVTs according to their localization in anterior, lateral, inferior, and septal and involvement of basal, medium, or apical portion. According to results, LVTs can be considered as a benign condition, not requiring further investigations in most cases. ANT, Anterior; API, apical; BAS, basal; INF, inferior; MED, medium; LAT, lateral; SEP, septal.

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Highlights

•	LVTs may cause clinical concern in athletes.
•	LVTs are common findings (29%) mostly in male, Afro-Caribbean, and endurance athletes.
•	LVTs in this population represented an expression of adaptive remodeling in elite athletes.
•	In the absence of alert criteria, there is no negative prognostic value to LVTs.

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Keywords : Trabeculations, Sports cardiology, Cardiomyopathies, Athlete's heart, Echocardiography

Abbreviations : BMI, BSA, CMR, ECG, ICC, LV, LVEF, LVNC, LVT, SCD, SVEB, TDI, TTE, VEB