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Objective <p>To investigate the differences in clinical phenotypes between children and adult patient groups with left ventricular non-compaction (LVNC) and to evaluate the predictive efficacy of various biomarkers for ventricular arrhythmias (VAs) in LVNC.</p> Methods <p>This study included 408 patients diagnosed with LVNC by cardiac magnetic resonance (CMR) between 2016 and 2023 (Children group &lt; 18 years, <i>n</i> = 135; Adult group ≥ 18 years, <i>n</i> = 273). Baseline data, imaging parameters, and biomarkers were collected. Multivariable logistic regression analysis was used to identify independent predictors of VAs in LVNC. The optimal cut-off value for NT-proBNP was determined using receiver-operating characteristic (ROC) curve analysis. A restricted cubic spline model was constructed to analyze the dose-response relationship. Finally, VAs risk was assessed using tertile stratification and subgroup analysis.</p> Results <p>Compared with the children group, the adult group showed significantly reduced cardiac function (LVEF-CMR 40.72% vs. 46.59%, <i>P</i> = 0.001), larger left ventricular end-diastolic diameter (TTE 59.23&#xa0;mm vs. 51.43&#xa0;mm, <i>P</i> &lt; 0.001), and higher prevalence of chest pain (56.8% vs. 41.5%) and dyspnea (49.8% vs. 24.4%). The children group had a higher proportion of congenital heart disease than the adult group (21.5% vs. 5.9%, <i>P</i> &lt; 0.001). Cardiac function and structure (LVEF, LVEDD, LAD) progressively worsened with increasing age. Worsening was more severe in patients comorbid with dilated cardiomyopathy, moderate/massive mitral regurgitation, and pulmonary hypertension. NT-proBNP was an independent predictor of VAs in LVNC (OR = 1.380, 95% CI: 1.062–1.794, <i>P</i> = 0.016). The area under the ROC curve was 0.72, with an optimal cut-off value of 576 pg/ml (Sensitivity 65.2%, Specificity 71.6%). When NT-proBNP &gt; 1029 pg/ml (Tertile 3, T3), the risk of VAs was 3.09 times that of the T1 group (95% CI: 1.034–9.257). This risk remained significantly increased even in the subgroup with LVEF &gt; 50% (OR = 2.16). Subgroup analysis revealed no interaction effects.</p> Conclusion <p>LVNC exhibits significant age-related heterogeneity, characterized predominantly by congenital abnormalities in childhood and by impaired cardiac function in adulthood. NT-proBNP serves as a strong predictive marker for VAs in LVNC. A risk stratification pathway based on thresholds of 576 pg/ml (screening threshold) and 1029 pg/ml (intervention node) shows promise for optimizing clinical decision-making.</p>

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Clinical phenotypes across age groups and the predictive value of NT-proBNP for ventricular arrhythmias in left ventricular non-compaction: a multicenter cohort study

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  • 发表日期：

    2026年1月24日

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  • Jinsong Jiang,
  • Xinmin Zhang,
  • Kunqi Yang,
  • Dan Kong,
  • Xiuchuan Qin,
  • Yuqing Sun,
  • Yanyan Xiao,
  • Yan Gu,
  • Bo Zhang,
  • Menghuai Ma,
  • Tao Tian,
  • Aihua Hu

摘要

Objective

To investigate the differences in clinical phenotypes between children and adult patient groups with left ventricular non-compaction (LVNC) and to evaluate the predictive efficacy of various biomarkers for ventricular arrhythmias (VAs) in LVNC.

Methods

This study included 408 patients diagnosed with LVNC by cardiac magnetic resonance (CMR) between 2016 and 2023 (Children group < 18 years, n = 135; Adult group ≥ 18 years, n = 273). Baseline data, imaging parameters, and biomarkers were collected. Multivariable logistic regression analysis was used to identify independent predictors of VAs in LVNC. The optimal cut-off value for NT-proBNP was determined using receiver-operating characteristic (ROC) curve analysis. A restricted cubic spline model was constructed to analyze the dose-response relationship. Finally, VAs risk was assessed using tertile stratification and subgroup analysis.

Results

Compared with the children group, the adult group showed significantly reduced cardiac function (LVEF-CMR 40.72% vs. 46.59%, P = 0.001), larger left ventricular end-diastolic diameter (TTE 59.23 mm vs. 51.43 mm, P < 0.001), and higher prevalence of chest pain (56.8% vs. 41.5%) and dyspnea (49.8% vs. 24.4%). The children group had a higher proportion of congenital heart disease than the adult group (21.5% vs. 5.9%, P < 0.001). Cardiac function and structure (LVEF, LVEDD, LAD) progressively worsened with increasing age. Worsening was more severe in patients comorbid with dilated cardiomyopathy, moderate/massive mitral regurgitation, and pulmonary hypertension. NT-proBNP was an independent predictor of VAs in LVNC (OR = 1.380, 95% CI: 1.062–1.794, P = 0.016). The area under the ROC curve was 0.72, with an optimal cut-off value of 576 pg/ml (Sensitivity 65.2%, Specificity 71.6%). When NT-proBNP > 1029 pg/ml (Tertile 3, T3), the risk of VAs was 3.09 times that of the T1 group (95% CI: 1.034–9.257). This risk remained significantly increased even in the subgroup with LVEF > 50% (OR = 2.16). Subgroup analysis revealed no interaction effects.

Conclusion

LVNC exhibits significant age-related heterogeneity, characterized predominantly by congenital abnormalities in childhood and by impaired cardiac function in adulthood. NT-proBNP serves as a strong predictive marker for VAs in LVNC. A risk stratification pathway based on thresholds of 576 pg/ml (screening threshold) and 1029 pg/ml (intervention node) shows promise for optimizing clinical decision-making.