Echocardiography in the diagnosis left ventricular noncompaction

Song, Ze–Zhou

doi:10.1186/1476-7120-6-64

Cardiovasc Ultrasound

2008

DOI: 10.1186/1476-7120-6-64

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Echocardiography in the diagnosis left ventricular noncompaction

Ze–Zhou Song

Abstract: Echocardiography is the method of choice to establish a diagnosis and determine a treatment plan for patients with noncompaction of ventricular myocardium (NVM). The 2-dimentional echocardiography, 3-dimentional echocardiography, color Doppler echocardiography and contrast-enhanced echocardiography are of critical importance for diagnosis and family screening of NVM.

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Cited by 20 publications

(14 citation statements)

References 23 publications

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“…The NVM is a rare congenital cardiomyopathy, which can be sporadic or familial [2,3]. Although initially described in children, several case series report this entity to also be present in adults, but rarely, in elderly patients [2][3][4].…”

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confidence: 99%

“…Although initially described in children, several case series report this entity to also be present in adults, but rarely, in elderly patients [2][3][4]. The prevalence of NVM is estimated to range between 0.05% and 0.24% of all echocardiographic investigations in recent studies, while its incidence in the general population is yet unknown [2,3]. Patients carrying NVM can remain asymptomatic or with only minimal symptoms for many years, but the reasons explaining the delayed onset of symptoms until an older age in some NVM patients remains to be elucidated.…”

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confidence: 99%

“…Patients carrying NVM can remain asymptomatic or with only minimal symptoms for many years, but the reasons explaining the delayed onset of symptoms until an older age in some NVM patients remains to be elucidated. The classic clinical manifestations include heart failure, dysrhythmias, and thromboembolic events [2,3]. As regards the therapeutic approach to these patients, the limited amount of available research suggests that the most reasonable approach is to use standard treatment for the general conditions that develop from NVM, including heart failure, dysrhythmias, and thromboembolic events [2,3].…”

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confidence: 99%

“…The classic clinical manifestations include heart failure, dysrhythmias, and thromboembolic events [2,3]. As regards the therapeutic approach to these patients, the limited amount of available research suggests that the most reasonable approach is to use standard treatment for the general conditions that develop from NVM, including heart failure, dysrhythmias, and thromboembolic events [2,3]. Since finding innovative and effective treatments for rare medical disorders is always a challenge, increased awareness by health care providers worldwide could help to identify a greater number of cases, to start appropriate treatments and, eventually, to find new therapeutic strategies.…”

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confidence: 99%

“…However, diagnosis by echocardiography is operator dependent, and requires attentive and experienced providers to ensure these patients are not misdiagnosed as having another form of cardiomyopathy, or are missed altogether [2,3].…”

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confidence: 99%

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Noncompaction of ventricular myocardium in an elderly woman

et al. 2009

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Noncompaction of ventricular myocardium (NVM) is classified among genetic cardiomyopathies, and is thought to be caused by failure of the myocardial compaction process during embryogenesis [1]. This leads to a hypertrabeculated left ventricular myocardium with deep intertrabecular recesses that communicate directly with the main ventricular chamber [2]. In this paper, we describe a case of NVM in an elderly patient.A 68-year-old woman was admitted to our Cardiology unit because of worsening dyspnea and peripheral edema. Eight years prior to admission, she had been diagnosed with hypertension and persistent atrial fibrillation, and was placed on warfarin therapy. Five years later, the patient was acutely admitted for dyspnea, and during the stay she had a dysrhythmic syncopal episode. On this occasion, after an extensive diagnostic work-up including coronary angiography, which revealed a normal coronary artery tree, she underwent the implantation of a biventricular pace-maker and cardioverter defibrillator, and was discharged with a diagnosis of dilated cardiomyopathy. At the time of the present admission, the patient was taking warfarin, furosemide 50 mg/day, ramipril 5 mg/day, digoxin 0.125 mg/ day, and bisoprolol 1.25 mg/day. The patient was in NYHA class IV, and on physical examination, she appeared acutely ill. She had a prominent jugular pulse, a holosystolic murmur over the mitral and aortic valves, reduced breath sounds and rales at both pulmonary bases, and peripheral leg edema. The ECG confirmed the presence of atrial fibrillation and left bundle branch block. A chest X-ray study revealed an enlarged cardiac silhouette and hilar congestion. Admission blood analyses were normal except for a plasma cholesterol (267 mg/dl) and pro-BNP (1,463 pg/ml, normal range 0-450). Echocardiographic examination revealed a dilated and globus left ventricle (tele-diastolic diameter 60 mm) with diffuse hypokinesia (ejection fraction 25%), bilateral atrial dilatation, moderate mitral and mild tricuspidal valve insufficiencies with an estimated systolic pulmonary pressure 55 mmHg, and diastolic dysfunction (E/A ratio [ 2). In the lateral wall and apical region, several trabeculations, typical of NVM, were observed (Fig. 1). The ratio between noncompacted and compacted myocardium in telediastole was 2.3. No other valvular abnormalities were observed. After two days of therapy with furosemide 40 mg i.v. bid the clinical condition improved, and the patient's medications were raised to ramipril to 10 mg/day, bisoprolol to 5 mg/day, and oral furosemide to 100 mg/day, while continuing therapy with warfarin and digoxin, and starting therapy with lovastatin 20 mg/day. The patient was discharged and followed-up for 6 months, and did not experience any further heart failure exacerbations. Her two sons agreed to be examined by echocardiographic screening, and were found to be free of NVM.The NVM is a rare congenital cardiomyopathy, which can be sporadic or familial [2,3]. Although initially described in children, several case series r...

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confidence: 99%

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Noncompaction of ventricular myocardium in an elderly woman

et al. 2009

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Echocardiography fails to detect left ventricular noncompaction in a cohort of patients with noncompaction on cardiac magnetic resonance imaging

Diwadkar

Nallamshetty

Rojas

et al. 2017

Clinical Cardiology

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Background Left ventricular noncompaction (LVNC) is a rare disorder characterized by increased left ventricular trabeculation, deep intertrabecular recesses, and a thin compacted myocardial layer with associated clinical sequelae. Cardiac imaging with echocardiogram and cardiac magnetic resonance (CMRI) can detect variable myocardial morphology including excessive trabeculations. Multiple CMRI and echocardiographic criteria have been offered that attempt to identify LVNC morphology. The aim of this study was to assess the utility of echocardiogram in identifying LVNC in a cohort of patients with LVNC detected on CMRI. Hypothesis Echocardiography fails to identify LVNC morphology in a large proportion of patients with LVNC/hypertrabeculation detected on CMRI. Methods There were 1060 CMRI studies collected from 2009 to 2015 at 2 institutions. The patients included in this study (n = 37) met the criteria for LVNC on CMRI and had complete CMRI and echocardiogram images Clinical and imaging data were retrospectively reviewed. Results Of the 37 patients with LVNC on CMRI, only 10 patients (27%) had LVNC identified on echocardiogram (P < 0.0001, 95% confidence interval: 25.7%‐66.2%). Echocardiography and CMRI were also significantly different in terms of identification of distribution of LVNC. Although 21 of 37 patients (57%) had evidence of LVNC in either the anterior or lateral walls on CMRI, there were 0 patients with LVNC detected in the anterior or lateral walls on echocardiogram (P = 0.019). Conclusions Echocardiogram fails to detect LVNC morphology/hypertrabeculation in a significant number of a cohort of patients with LVNC on CMRI. LVNC may be missed if echocardiogram is the only imaging modality performed in a cardiac evaluation.

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Echocardiographic Evaluation of Cardiac Masses

Kurnick,

Akivis,

Sabu

et al. 2023

Curr Cardiol Rep

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Echocardiography in the diagnosis left ventricular noncompaction

Cited by 20 publications

References 23 publications

Noncompaction of ventricular myocardium in an elderly woman

Noncompaction of ventricular myocardium in an elderly woman

Echocardiography fails to detect left ventricular noncompaction in a cohort of patients with noncompaction on cardiac magnetic resonance imaging

Echocardiographic Evaluation of Cardiac Masses

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