Left Ventricular Noncompaction: Anatomical Phenotype or Distinct Cardiomyopathy?

Jonathan R. Weir-McCall, Phey Ming Yeap, Carla Papagiorcopulo, Kerrie Fitzgerald, Stephen J. Gandy, Matthew Lambert, Jill J. F. Belch, Ian Cavin, Roberta Littleford, Jennifer A. MacFarlane, Shona Z. Matthew, R. Stephen Nicholas, Allan D. Struthers, Frank Sullivan, Shelley A. Waugh, Richard D. White, J. Graeme Houston (Lead / Corresponding author)

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Abstract

Background: There is considerable overlap between Left Ventricular Non-Compaction(LVNC) and other cardiomyopathies, and it has been reported in up to 40% of the general population raising the question whether it is a distinct pathological entity, a remodelling epiphenomenom or merely an anatomical phenotype.

Objectives: To determine the prevalence and predictors of non-compaction in a healthy population using four cardiac magnetic resonance imaging diagnostic criteria.

Methods: 1651 volunteers >40 yrs with no history of cardiovascular disease(CVD), a 10 year risk of CVD less than 20% and a B-type natriuretic peptide (BNP) level greater than their gender-specific median underwent an MRI scan as part of the Tayside Screening for Cardiac Events(TASCFORCE) study. LVNC ratios were measured on the horizontal and vertical long axis(LAX) bSSFP sequences. All individuals with a non-compaction ratio of ≥2 underwent short axis systolic (SAXSYST) and diastolic (SAXDIAST) LVNC ratio measurements and quantifaction of non-compacted and compacted myocardial mass(NCMASS) ratios. Those who met all 4 criteria were considered to have LVNC.

Results: Of 14802 participants included in the final analysis, 219(14.8%) met at least one diagnostic criterion for LVNC, 117(7.9%) met 2 criteria, 63(4.3%) met 3 criteria and 19(1.3%) met all 4 diagnostic criteria. There was no difference in demographic or allometric measures between those with and those without LVNC. LAX non-compaction ratios were the least specific, with the current diagnostic criteria being positive in 219(14.8%), while NCMASS ratio was the most specific, only being met in 61(4.4%) of the population.

Conclusion: A significant proportion of the an asymptomaticpopulation free from cardiovascular disease satisfy all currently used CMR diagnostic criteria for LVNC, suggesting that either these all have poor specificity for LVNC, or that LVNC is an anatomical phenotype rather than a distinct cardiomyopathy.
Original languageEnglish
Pages (from-to)2157-2165
Number of pages9
JournalJournal of the American College of Cardiology
Volume68
Issue number20
Early online date14 Nov 2016
DOIs
Publication statusPublished - 15 Nov 2016

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Keywords

  • anatomy
  • cardiomyopathy
  • diagnostic
  • left ventricular noncompaction
  • magnetic resonance imaging

Cite this

Weir-McCall, J. R., Yeap, P. M., Papagiorcopulo, C., Fitzgerald, K., Gandy, S. J., Lambert, M., Belch, J. J. F., Cavin, I., Littleford, R., MacFarlane, J. A., Matthew, S. Z., Nicholas, R. S., Struthers, A. D., Sullivan, F., Waugh, S. A., White, R. D., & Houston, J. G. (2016). Left Ventricular Noncompaction: Anatomical Phenotype or Distinct Cardiomyopathy? Journal of the American College of Cardiology, 68(20), 2157-2165. https://doi.org/10.1016/j.jacc.2016.08.054