Epidemiology of Left Ventricular False Tendons: Clinical Correlates in the Framingham Heart Study
published online 08 May 2009.
Objective
The study objective was to describe the echocardiographic characteristics and investigate the clinical correlates and prognostic significance of left ventricular false tendons (LVFTs). Although LVFTs are generally considered as anatomic variants, they have been associated with innocent precordial murmurs and electrocardiographic abnormalities in small case series. The correlates of LVFTs in the community are unknown.
Methods
We compared 101 Framingham Study participants with LVFTs (mean age 56 years, 45% were women) on routine two-dimensional echocardiograms with 151 referents without LVFTs (mean age 57 years, 44% were women). We examined the cross-sectional clinical, electrocardiographic (rest and ambulatory), and echocardiographic correlates of LVFTs using logistic regression models and evaluated the prospective association between LVFTs and all-cause mortality using Cox proportional hazards regression models.
Results
A total of 107 LVFTs (94 simple with 2 points of attachment and 13 complex/branching type with 3 or more points of attachment) were identified in 101 participants. LVFTs were most commonly visualized in the apical 4-chamber view (81%) and predominantly localized to the apical third of the left ventricular cavity (78%). LVFTs were associated with the presence of innocent precordial murmurs (multivariable adjusted odds ratio [OR] 5.55, 95% confidence interval [CI], 1.40-21.94) and electrocardiographic left ventricular hypertrophy (OR 4.43; 95% CI, 1.08-18.25). Body mass index was inversely related to the presence of LVFTs (per kilogram/meters squared increment; OR 0.94; 95% CI, 0.88-0.99). LVFTs were not associated with QRS axis deviation, ventricular premature beats, or repolarization abnormalities (all P values > .20). During a mean (± standard deviation) follow-up of 7.7 (±1.6) years, 15 participants with LVFTs and 19 participants without LVFTs died. In multivariable analyses, the presence of LVFTs was not associated with the risk of death (P = .92).
Conclusion
In our community-based sample of middle-aged to elderly white women and men, LVFTs were more likely to be identified in individuals with lower body mass index and cross-sectionally associated with the presence of innocent precordial murmurs and electrocardiographic left ventricular hypertrophy, but they were not associated with the risk of mortality.
Framingham, Boston, and West Roxbury, Massachusetts
National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts (S.K., E.J.B., J.C.E., R.S.V.); Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts (S.K.); Harvard Medical School, Boston, Massachusetts (S.K.); Boston VA Healthcare System, West Roxbury, Massachusetts (J.A.); and Section of Preventive Medicine, and Cardiology section, Boston University School of Medicine, Boston, Massachusetts (E.J.B, R.S.V.)
Reprint requests: Satish Kenchaiah, MD, MPH, NHLBI's Framingham Heart Study, 73 Mt. Wayte Ave., Suite 2, Framingham, MA 01702.
This work was supported in part by a contract (N01-HC-25195) with the National Heart, Lung, and Blood Institute and by a research career award (2K24 HL04334) and R01HL080124 from the National Heart, Lung and Blood Institute, Bethesda, Maryland (to Dr Vasan).
ABSTRACT