Left Ventricular Trabeculation: Arrhythmogenic and Clinical Significance in Elite Athletes

Giuseppe Di Gioia; Simone Pasquale Crispino; Sara Monosilio; Viviana Maestrini; Antonio Nenna; Alessandro Spinelli; Erika Lemme; Maria Rosaria Squeo; Antonio Pelliccia

doi:10.1016/j.echo.2024.03.003

Left Ventricular Trabeculation: Arrhythmogenic and Clinical Significance in Elite Athletes

J Am Soc Echocardiogr. 2024 Mar 15:S0894-7317(24)00110-X. doi: 10.1016/j.echo.2024.03.003. Online ahead of print.

Authors

Giuseppe Di Gioia¹, Simone Pasquale Crispino², Sara Monosilio³, Viviana Maestrini³, Antonio Nenna⁴, Alessandro Spinelli⁵, Erika Lemme⁵, Maria Rosaria Squeo⁵, Antonio Pelliccia⁵

Affiliations

¹ Institute of Sports Medicine and Science, National Italian Olympic Committee, Rome, Italy; Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico," Rome, Italy. Electronic address: dottgiuseppedigioia@gmail.com.
² Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
³ Institute of Sports Medicine and Science, National Italian Olympic Committee, Rome, Italy; Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
⁴ Department of Heart Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
⁵ Institute of Sports Medicine and Science, National Italian Olympic Committee, Rome, Italy.

PMID: 38492683
DOI: 10.1016/j.echo.2024.03.003

Abstract

Introduction: Left ventricular (LV) trabeculations (LVTs) are common findings in athletes. Limited information exists regarding clinical significance, management, and outcome.

Objectives: The purpose of this study is to examine 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 electrocardiogram, echocardiogram, and exercise stress test. Individuals with a definite diagnosis of LV noncompaction (LVNC) were excluded; we focused on athletes with LVTs not meeting the criteria for LVNC.

Results: Four hundred thirty-five (29.1%) athletes presented with LVTs, which were more frequent in male athletes (62.1% vs 53.5%, P = .002) and Black athletes compared with Caucasian (7.1% vs 2.4%, P < .0001) and endurance athletes (P = .0005). No differences were found with relation to either the site or extent of trabeculations. Endurance athletes showed a higher proportion of LVTs and larger LV volumes (end-diastolic and end-systolic, respectively, 91.5 ± 19.8 mL vs 79.3 ± 29.9 mL, P = .002; and 33.1 ± 10 mL vs 28.6 ± 11.7 mL, P = .007) and diastolic pattern with higher E wave (P = .01) and e' septal velocities (P = .02). Ventricular arrhythmias were found in 14% of LVTs versus 11.6% of athletes without LVTs (P = .22). Neither the location nor the LVTs' extension were correlated to ventricular arrhythmias. At 52 ± 32 months of follow-up, no differences in arrhythmic burden were observed (11.1% in LVT athletes vs 10.2%, P = .51).

Conclusions: Left ventricular trabeculations are quite common in athletes, mostly male, Black, and endurance, likely as the expression of adaptive remodeling. In the absence of associated clinical abnormalities, such as LV systolic and diastolic impairment, electrocardiogram repolarization abnormalities, or family evidence of cardiomyopathy, athletes with LVTs have benign clinical significance and should not require further investigation.

Keywords: Athlete's heart; Cardiomyopathies; Echocardiography; Sports cardiology; Trabeculations.