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

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.