Left ventricular trabeculation: arrhythmogenic and clinical significance in elite athletes

Introduction Left ventricular trabeculations (LVTs) are common findings in athletes. Limited information exists regarding clinical significance, management, and outcome. Objectives To study 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 ECG, echocardiogram, and exercise stress test. Individuals with a definite diagnosis of left ventricular non-compaction (LVNC) were excluded, focusing on athletes with LVTs not meeting the criteria for LVNC. Results Four-hundred thirty-five (29.1%) athletes presented LVTs. LVTs were more frequent in males (62.1% vs. 53.5%, p=0.002), black athletes compared to Caucasian (7.1% vs. 2.4%, p<0.0001) and endurance athletes (p=0.0005). No differences were found either with relation to site or extent of trabeculations. Endurance athletes showed a higher proportion of LVTs and larger left ventricular (LV) volumes (end-diastolic and end-systolic, respectively 91.5±19.8 mL vs. 79.3±29.9 mL, p=0.002 and 33.1±10mL vs. 28.6±11.7mL, p=0.007) and diastolic pattern with higher E wave (p=0.01) and e’ septal velocities (p=0.02). Ventricular arrhythmias were found in 14% of LVTs vs 11.6% of athletes without LVTs (p=0.22). Neither the location nor the LVTs extension were correlated to ventricular arrhythmias. At 52±32 months follow-up, no differences in arrhythmic burden were observed (11.1% in LVTs athletes vs 10.2%, p=0.51). Conclusions LVTs are quite common in athletes, mostly male, black and endurance, likely as the expression of adaptive remodelling. In the absence of associated clinical abnormalities, such as LV systolic and diastolic impairment, ECG repolarization abnormalities, or family evidence of cardiomyopathy, athletes with LVTs have benign clinical significance and should not require further investigations.