Study in Spain and Netherlands finds no independent risk from hypertrabeculation

A large international study found left ventricular hypertrabeculation does not worsen outcomes in dilated cardiomyopathy patients, challenging a long-held association with poor prognosis. Using cardiac MRI and genetic data from 1,160 patients at 22 Spanish and Dutch centers, researchers found no increased risk of embolism, advanced heart failure, or severe arrhythmias. The findings, published in Circulation, support treating hypertrabeculation as a morphological trait, not a distinct disease. Previously linked to higher risk and sometimes treated with preventive anticoagulation, hypertrabeculation did not raise embolism risk even in high-risk patients. Prognosis depended on ejection fraction, myocardial fibrosis, and genetic alterations.