Epidemiology of Left Ventricular False Tendons: Clinical Correlates in the Framingham Heart Study

Abstract

Objectives To describe the echocardiographic characteristics and investigate the clinical correlates and prognostic significance of left ventricular false tendons (LVFTs). Background Although LVFTs are generally considered as anatomic variants, they have been associated with innocent precordial murmurs and electrocardiographic abnormalities in small case series. The correlates of LVFTs in the community are unknown. Methods We compared 101 Framingham Study participants with LVFTs (mean age 56 years, 45% women) on routine two-dimensional echocardiograms with 151 referents without LVFTs (mean age 57 years, 44% women). We examined the cross-sectional clinical, electrocardiographic (rest and ambulatory), and echocardiographic correlates of LVFTs using logistic regression models, and evaluated the prospective association between LVFTs and all-cause mortality using Cox proportional hazards regression models. Results A total of 107 LVFTs (94 simple with two points of attachment, and 13 complex/branching type with three or more points of attachment) were identified in 101 participants. LVFTs were most commonly visualized in the apical four chamber view (81%) and were predominantly localized to apical-third of the LV cavity (78%). LVFTs were associated with the presence of innocent precordial murmurs (multivariable adjusted odds ratio [OR] 5.55, 95% confidence interval [CI] 1.40-21.94), and electrocardiographic LV hypertrophy (OR 4.43, 95% CI 1.08-18.25). Body mass index (BMI) was inversely related to the presence of LVFTs (per kg/m2 increment, OR 0.94, 95% CI 0.88-0.99). LVFTs were not associated with QRS axis deviation, ventricular premature beats or repolarization abnormalities (all p-values >0.20). During a mean (±SD) follow-up of 7.7 (±1.6) years, 15 participants with and 19 without LVFTs died. In multivariable analyses, presence of LVFTs was not associated with the risk of death (p=0.92). Conclusions In our community-based sample of middle-aged to elderly white women and men, LVFTs were more likely to be identified in individuals with lower BMI, were cross-sectionally associated with the presence of innocent precordial murmurs and electrocardiographic LV hypertrophy, but were not associated with the risk of mortality.

Left ventricular false tendons: echocardiographic characteristics in the Polish population

“…Apical location of the FT in our study was similar to that of the group of 107 subjects from the Framingham population [11], and it was also the most common site of the structure. Only 3 longitudinal FTs (i.e.…”

“…No electrocardiographic criteria of LV hypertrophy were found in patients free of arterial hypertension, which seems to contradict the putative link between FT and LV hypertrophy suggested by Kenchaiah et al [11]. Similarly, no features suggestive of a generalised infection or inflammation were identified in any of the patients in our study group.…”

“…extending through all 3 levels of the LV lumen) were found. Single FT was slightly more prevalent in our study group compared to the work by Kenchaiah et al [11] (94%), and the prevalence of 2 or more tendons was slightly lower (double FT -5%, triple FT -1%).…”

“…It was also noted that it occurs more frequently in individuals with low body mass index values and with other heart abnormalities [11].…”

“…It is described in 40-62% of the examined hearts depending on age and additional heart abnormalities. On echocardiography, the range is much wider, depending mainly on study design and age group, ranging 1.6-78% [11,17,21]. The prevalence of FT in a prospective echocardiographic study of 488 subjects, published in 1986, amounted to 25%.…”