ES measures of LVNC have stronger associations with events, CHF, and systolic dysfunction than other measures.

The distinction between normal right ventricular (RV) trabeculations from abnormal has been difficult. We evaluated whether RV volume and function are related to left ventricular (LV) noncompaction (NC) cardiomyopathy and clinical events. Trabeculations/possible LVNC by cardiac magnetic resonance imaging (cMRI) was retrospectively observed among 105 consecutive cases. We measured LV end-systolic (ES) noncompacted:compacted ratio, RV ejection fraction (EF), RV apical trabecular thickness, and RV end-diastolic (ED) noncompacted:compacted ratio. A control group of 40 subjects was also reviewed to assess the exploratory measures. Comparing those with LV ES noncompacted:compacted ratio ≥ 2, < 2, and the normal control group, adjusted means for RV apical trabecular thickness and RV ED noncompacted:compacted ratio were generated. Logistic regression was used to evaluate the association of composite events traditionally associated with LV NC with RV EF after adjustment for above covariates, cardiovascular risk factors, delayed enhancement, LV EF, and LV ES noncompacted:compacted ratio. Analysis of RV morphology found greater apical trabecular thickness among those with LV ES noncompacted:compacted ratio ≥ 2 as compared with LV ES noncompacted:compacted ratio < 2 or normal control group (31 ± 5 mm vs. 27 ± 2.6 mm vs. 22 ± 4 mm; p = 0.03 and p = 0.003, respectively). There was no difference between the groups in relation to the RV end-diastolic (ED) noncompacted:compacted ratio . Low RV EF and LV ES noncompacted:compacted ratio ≥ 2 had significant association with clinical events in this population even after adjusting for clinical and imaging parameters (p = 0.04 and p < 0.001, respectively). In conclusion, RV dysfunction in a morphologic LVNC population is strongly associated with adverse clinical events. LVNC is associated with increased trabeculations of the RV apex.

Our objective was to determine if increased cardiovascular (CV) stiffness is associated with disability in middle-aged and older adults at risk for congestive heart failure. CV stiffness (brachial pulse pressure/left ventricular stroke volume indexed to body surface area) and total disability (the summed assessment of activities of daily living, mobility, and instrumental activities of daily living) were measured in 445 individuals. A subset of 109 randomly selected individuals also underwent physical function testing. Total disability was associated with CV stiffness (p = .01), driven by an association with mobility (p = .005), but not activities of daily living (p = .13) or instrumental activities of daily living (p = .61). After accounting for age, these correlations remained significant for men (p = .04), but not for women. CV stiffness was also associated with increased 400-m walk time (p = .02). In middle-aged and elderly men at risk for congestive heart failure, CV stiffness is associated with decreased mobility and physical function, and increased overall disability.Key Words: Cardiovascular stiffness-Disability-Congestive heart failure. Decision Editor: Rafael de Cabo, PhDPhysical disability reduces quality of life, increases health care costs (due to increased need for support services), and is an independent predictor of mortality (1,2). Mobility and activities of daily living are necessary for maintaining basic independent functioning in middle-aged and older individuals (3). Therapy targeted to attenuate the factors that promote disability could improve quality of life and prognosis in older individuals. Such therapy could provide a mortality benefit, as it has been shown in the elderly individual that all levels of physical activity are associated with lower risk of incident acute myocardial infarction, stroke, and cardiovascular (CV) mortality (4). Previously, it has been shown that abnormally increased cardiac and aortic stiffness is independently associated with reduced peak exercise capacity in elderly individuals with and without left ventricular (LV) systolic dysfunction and congestive heart failure (CHF) (5-10). We hypothesized that similar to exercise capacity, increased CV stiffness would be associated with increased disability in middleaged and elderly individuals at risk for their first episode of symptomatic CHF. To test this hypothesis, we noninvasively assessed CV stiffness (using CV magnetic resonance or CMR) and disability. Additionally, in a randomly selected subgroup of individuals, we formally measured physical function.

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