Cardiac magnetic resonance imaging predictors of outcomes in noncompaction cardiomyopathy: A systematic review and meta-analysis.

Background Cardiac magnetic resonance (CMR) is the reference standard for diagnosing left ventricular (LV) noncompaction cardiomyopathy (NCCM). However, reported associations between CMR-derived structural parameters and major adverse cardiovascular and cerebrovascular events (MACCE) remain inconsistent. This study aimed to evaluate CMR characteristics in NCCM compared with controls and assess their associations with MACCE based on published case-control studies. Methods The Cochrane Collaboration methodological framework was followed. In the primary analysis, CMR-derived parameters were compared between NCCM patients and controls. In the secondary analysis, these parameters were compared between NCCM patients with and without MACCE. Results The pooled analysis using a random-effects model demonstrates that patients with NCCM exhibit a markedly reduced CMR-derived left ventricular ejection fraction (LVEF), feature tracking derived strain indices and higher LV volumes compared with controls. CMR parameters, including LVEF, ventricular volumes, and the extent of trabeculation showed modest or no association with adverse outcomes. In contrast, late gadolinium enhancement (LGE) was the imaging marker most consistently associated with MACCE (RR = 2.78; 95% CI 1.91-4.05; p < 0.00001). Structural alterations such as thinning of the compacted myocardium was also associated with MACCE (HR 2.36; 95% CI 1.70-3.26; p < 0.0001). Conclusions This systematic review and meta-analysis demonstrate that NCCM is characterized by marked systolic dysfunction, adverse remodeling, and impaired strain compared to healthy controls. While conventional parameters including LVEF, LVEDV, and LVESV carry predictive value, the extent of trabeculation did not demonstrate prognostic utility. Instead, tissue characterization and advanced structural metrics provide vital prognostic information beyond these standard markers; specifically, the presence of LGE and CMR-derived myocardial thinning emerged as the most potent independent predictors of adverse clinical outcomes.