{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T07:42:58Z","timestamp":1789544578420,"version":"build-2803163510"},"reference-count":50,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2026,8,4]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Left ventricular (LV) hypertrabeculation, formerly termed LV noncompaction, is a heterogeneous myocardial entity linked to adverse cardiovascular outcomes. This study evaluated embolic risk in patients with dilated cardiomyopathy (DCM) according to the presence of hypertrabeculation and examined its prevalence and prognostic relevance across DCM genotypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Clinical data from 1160 patients with DCM evaluated by cardiac magnetic resonance imaging and genetic testing (n=997 [86%]) were collected from 22 international centers. End points included embolic events, advanced heart failure events, and major ventricular arrhythmias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      LV hypertrabeculation was identified in 354 patients (30.5%) by fractal analysis and in 343 (29.7%) according to Petersen criteria, with good concordance. After a median follow-up of 5.1 years (interquartile range, 2.8\u20137.4), embolic events occurred in 37 patients (3.2%), advanced heart failure in 62 (5.3%), and major ventricular arrhythmias in 136 (11.7%). Hypertrabeculation was not associated with increased embolic risk (hazard ratio, 1.5 [95% CI, 0.75\u20133.00]), even among patients in sinus rhythm with LV ejection fraction \u226440% (hazard ratio, 1.89 [95% CI, 0.7\u20135.5]). In contrast, atrial fibrillation and reduced LV ejection fraction were associated with embolic events (both\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.01). LV hypertrabeculation was not associated with an increased risk of major ventricular arrhythmias or advanced heart failure; genotype, LV ejection fraction, and late gadolinium enhancement emerged as the main predictors of adverse outcomes. The prevalence of LV hypertrabeculation varied across genotypes, with the highest prevalence observed in patients with sequence variants in motor sarcomeric genes (58%),\n                      <jats:italic toggle=\"yes\">TTN<\/jats:italic>\n                      (38%), and genotype-negative status (33%), and the lowest prevalence observed among those with variants in cytoskeletal\/Z-disk (7%) and nuclear envelope (5%) genes. Hypertrabeculation was not associated with adverse outcomes within any genotype.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Although LV hypertrabeculation is common in DCM, it is not associated with worse outcomes and should not prompt differential clinical management. The embolic risk in patients with DCM and hypertrabeculation is low, including in those with reduced LV ejection fraction without atrial fibrillation, and does not support prophylactic anticoagulation in these patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.125.078536","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T18:00:21Z","timestamp":1785780021000},"page":"440-453","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Left Ventricular Hypertrabeculation and Prognosis in Dilated Cardiomyopathy"],"prefix":"10.1161","volume":"154","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2127-5287","authenticated-orcid":true,"given":"Nerea","family":"Mora-Ayestar\u00e1n","sequence":"first","affiliation":[{"name":"Department of Cardiology, Hospital Universitario Puerta de Hierro, Instituto de Investigaci\u00f3n Sanitaria Puerta de Hierro Majadahonda (IDIPHIM), Madrid, Spain (N.M.-A., N.R.-L., J.G.M., P.G.-P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0868-1707","authenticated-orcid":true,"given":"Noemi","family":"Ramos-Lopez","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Universitario Puerta de Hierro, Instituto de Investigaci\u00f3n Sanitaria Puerta de Hierro Majadahonda (IDIPHIM), Madrid, Spain (N.M.-A., N.R.-L., J.G.M., P.G.-P.)."},{"name":"Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (N.R.-L., J.P.O., A.G.-\u00c1., P.G.-P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7966-0313","authenticated-orcid":true,"given":"Juan Pablo","family":"Ochoa","sequence":"additional","affiliation":[{"name":"Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (N.R.-L., J.P.O., A.G.-\u00c1., P.G.-P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4484-7842","authenticated-orcid":true,"given":"Amaia Yuan","family":"Ibargoyen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u00c1rea del Coraz\u00f3n, Hospital Universitario de Navarra, Pamplona, Spain (A.Y.I., M.S., G.L.-L., M.T.B.-E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduard","family":"Claver-Garrido","sequence":"additional","affiliation":[{"name":"Bioheart Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d\u2019Investigaci\u00f3 Biom\u00e8dica de Bellvitge (IDIBELL; E.C.-G., C.D.-L., A.D.), l\u2019Hospitalet de Llobregat, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"G\u00f3mez-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, Madrid, Spain (C.G.-G., E.R.G., M.A.E.-C.)."},{"name":"Facultad de Medicina, Universidad Complutense de Madrid, Spain (C.G.-G., E.R.G., M.A.E.-C.)."},{"name":"Instituto de Investigaci\u00f3n Sanitaria Gregorio Mara\u00f1\u00f3n, Madrid, Spain (C.G.-G., E.R.G., M.A.E.-C.)."},{"name":"CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain (C.G.-G., M.G.-D., G.C.-M., M.N.-P., J.M.G.-P., G.C.-V., A.B.-G., R.S.-B., A.G.-\u00c1., M.B., E.Z., E.R.G., E.V., J.L.-F., M.S.-M., R.B.-V., A.D., M.A.E.-C., J.F.R.-P., J.G.M., P.G.-P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1600-7907","authenticated-orcid":true,"given":"Ahmad S.","family":"Amin","sequence":"additional","affiliation":[{"name":"Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Failure &amp; Arrhythmias, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands (A.S.A., E.P., C.R.B.)."},{"name":"European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD\u2013Heart), Amsterdam, The Netherlands (A.S.A., G.C.-M., M.N.-P., E.P., J.L.-F., C.R.B., J.F.R.-P., J.G.M., P.G.-P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0726-9646","authenticated-orcid":true,"given":"Mar\u00eda","family":"Gallego-Delgado","sequence":"additional","affiliation":[{"name":"CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain (C.G.-G., M.G.-D., G.C.-M., M.N.-P., J.M.G.-P., G.C.-V., A.B.-G., R.S.-B., A.G.-\u00c1., M.B., E.Z., E.R.G., E.V., J.L.-F., M.S.-M., R.B.-V., A.D., M.A.E.-C., J.F.R.-P., J.G.M., P.G.-P.)."},{"name":"Department of Cardiology, CSUR Cardiopat\u00edas Familiares, Hospital Universitario de Salamanca, Gerencia Regional de Salud de Castilla y Le\u00f3n, Salamanca, Spain (M.G.-D., E.V.)."},{"name":"Instituto de Investigaci\u00f3n Biom\u00e9dica de Salamanca, Spain (M.G.-D., E.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7122-320X","authenticated-orcid":true,"given":"Guillem","family":"Casas-Masnou","sequence":"additional","affiliation":[{"name":"CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain (C.G.-G., M.G.-D., G.C.-M., M.N.-P., J.M.G.-P., G.C.-V., A.B.-G., R.S.-B., A.G.-\u00c1., M.B., E.Z., E.R.G., E.V., J.L.-F., M.S.-M., R.B.-V., A.D., M.A.E.-C., J.F.R.-P., J.G.M., P.G.-P.)."},{"name":"European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD\u2013Heart), Amsterdam, The Netherlands (A.S.A., G.C.-M., M.N.-P., E.P., J.L.-F., C.R.B., J.F.R.-P., J.G.M., P.G.-P.)."},{"name":"Department of Cardiology, Vall d\u2019Hebron Hospital Universitari (G.C.-M., J.L.-F., J.F.R.-P.), Vall d\u2019Hebron Barcelona Hospital Campus, Spain."},{"name":"Cardiovascular Diseases, Vall d\u2019Hebron Institut de Recerca (VHIR; G.C.-M., J.L.-F., J.F.R.-P.), Vall d\u2019Hebron Barcelona Hospital Campus, Spain."},{"name":"Department of Medicine, Universitat Aut\u00f2noma de Barcelona, Bellaterra, Spain (G.C.-M., J.L.-F., J.F.R.-P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6254-6039","authenticated-orcid":true,"given":"Marina","family":"Navarro-Pe\u00f1alver","sequence":"additional","affiliation":[{"name":"CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain (C.G.-G., M.G.-D., G.C.-M., M.N.-P., J.M.G.-P., G.C.-V., A.B.-G., R.S.-B., A.G.-\u00c1., M.B., E.Z., E.R.G., E.V., J.L.-F., M.S.-M., R.B.-V., A.D., M.A.E.-C., J.F.R.-P., J.G.M., P.G.-P.)."},{"name":"European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD\u2013Heart), Amsterdam, The Netherlands (A.S.A., G.C.-M., M.N.-P., E.P., J.L.-F., C.R.B., J.F.R.-P., J.G.M., P.G.-P.)."},{"name":"Inherited Cardiac Disease Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain 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M\u00e1laga, Spain (J.M.G.-P.)."},{"name":"Departamento de Medicina y Dermatolog\u00eda, Universidad de M\u00e1laga, Spain (J.M.G.-P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0325-7349","authenticated-orcid":true,"given":"Francisco J.","family":"Bermudez-Jimenez","sequence":"additional","affiliation":[{"name":"Servicio de Cardiolog\u00eda, Hospital Universitario Virgen de las Nieves, Granada, Spain (F.J.B.-J.)."},{"name":"Instituto de Investigaci\u00f3n Biosanitaria ibs Granada, Spain (F.J.B.-J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6014-0206","authenticated-orcid":true,"given":"Maria Victoria","family":"Mogoll\u00f3n-Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Complejo Hospitalario Universitario de C\u00e1ceres, Spain (M.V.M.-J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6945-1446","authenticated-orcid":true,"given":"Gonzalo","family":"Cabez\u00f3n-Villalba","sequence":"additional","affiliation":[{"name":"CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain (C.G.-G., M.G.-D., G.C.-M., M.N.-P., J.M.G.-P., G.C.-V., A.B.-G., R.S.-B., A.G.-\u00c1., M.B., E.Z., E.R.G., E.V., J.L.-F., M.S.-M., R.B.-V., A.D., M.A.E.-C., J.F.R.-P., J.G.M., P.G.-P.)."},{"name":"Servicio de Cardiolog\u00eda del Hospital Cl\u00ednico de Valladolid (HCUV), Spain (G.C.-V.)."},{"name":"Instituto de Investigaci\u00f3n Biosanitaria de Valladolid (IBioVALL), Spain (G.C.-V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3044-197X","authenticated-orcid":true,"given":"Antoni","family":"Bayes-Genis","sequence":"additional","affiliation":[{"name":"CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain (C.G.-G., M.G.-D., G.C.-M., M.N.-P., J.M.G.-P., G.C.-V., A.B.-G., R.S.-B., A.G.-\u00c1., M.B., E.Z., E.R.G., E.V., J.L.-F., M.S.-M., R.B.-V., A.D., M.A.E.-C., J.F.R.-P., J.G.M., P.G.-P.)."},{"name":"Heart Institute, Hospital Universitari Germans Trias i Pujol, Canyet, Badalona, Spain (A.B.-G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7362-1922","authenticated-orcid":true,"given":"Vicente","family":"Climent-Pay\u00e1","sequence":"additional","affiliation":[{"name":"Heart Failure and Inherited Cardiac Diseases Unit, Cardiology Department, Dr Balmis General University Hospital, Alicante, Spain (V.C.-P.)."},{"name":"Institute for Health and Biomedical Research of Alicante (ISABIAL), Spain (V.C.-P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1038-9710","authenticated-orcid":true,"given":"Rafael","family":"Salguero-Bodes","sequence":"additional","affiliation":[{"name":"CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain (C.G.-G., M.G.-D., G.C.-M., M.N.-P., J.M.G.-P., G.C.-V., A.B.-G., R.S.-B., A.G.-\u00c1., M.B., E.Z., E.R.G., E.V., J.L.-F., M.S.-M., R.B.-V., A.D., M.A.E.-C., J.F.R.-P., J.G.M., P.G.-P.)."},{"name":"Department of Cardiology, Hospital Universitario 12 de Octubre, Instituto de Investigaci\u00f3n Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain (R.S.-B.)."},{"name":"Facultad de Medicina, Universidad Complutense, Madrid, Spain (R.S.-B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1718-2424","authenticated-orcid":true,"given":"Ana","family":"Garc\u00eda-\u00c1lvarez","sequence":"additional","affiliation":[{"name":"Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (N.R.-L., J.P.O., A.G.-\u00c1., P.G.-P.)."},{"name":"CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain (C.G.-G., M.G.-D., G.C.-M., M.N.-P., J.M.G.-P., G.C.-V., A.B.-G., 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