Quantification of left ventricular trabeculae using cardiovascular magnetic resonance for the diagnosis of left ventricular non-compaction: evaluation of trabecular volume and refined semi-quantitative criteria

Abstract

BackgroundLeft ventricular non-compaction (LVNC) is an unclassified cardiomyopathy and there is no consensus on the diagnosis of LVNC. The aims of this study were to establish quantitative methods to diagnose LVNC using cardiovascular magnetic resonance (CMR) and to suggest refined semi-quantitative methods to diagnose LVNC.MethodsThis retrospective study included 145 subjects with mild to severe trabeculation of the left ventricle myocardium [24 patients with isolated LVNC, 33 patients with non-isolated LVNC, 30 patients with dilated cardiomyopathy (DCM) with non-compaction (DCMNC), 27 patients with DCM, and 31 healthy control subjects with mild trabeculation]. The left ventricular (LV) ejection fraction, global LV myocardial volume, trabeculated LV myocardial volume, and number of segments with late gadolinium enhancement were measured. In addition, the most prominent non-compacted (NC), compacted (C), normal mid-septum, normal mid-lateral wall, and apical trabeculation thicknesses on the end-diastolic frames of the long-axis slices were measured.ResultsIn the patients with isolated LVNC, the percentage of trabeculated LV volume (TV%, ​42.6 ± 13.8 %) ​relative to total LV myocardial volume was 1.4 times higher than in those with DCM (30.3 ± 14.3 %, p < 0.001), and 1.7 times higher than in the controls (24.8 ± 7.1 %, p < 0.001). However, there was no significant difference in TV% between the isolated LVNC and DCMNC groups (47.1 ± 17.3 % in the DCMNC group; p = 0.210). The receiver operating characteristic curve analysis using Jenni’s method for CMR classification as the standard diagnostic criteria revealed that a value of TV% above 34.6 % was predictive of NC with a specificity of 89.7 % (CI: 74.2 - 98.0 %) and a sensitivity of 66.1 % (CI: 52.6 - 77.9 %). A value of NC/septum over 1.27 was considered predictive for NC with a specificity of 82.8 % (CI: 64.2 - 94.2 %) and a sensitivity of 57.6 % (CI: 44.1 - 70.4 %). In addition, a value of apex/C above 3.15 was considered predictive of NC with a specificity of 93.1 % (CI: 77.2 - 99.2 %) and a sensitivity of 69.5 % (CI: 56.1 - 80.8 %).ConclusionsA trabeculated LV myocardial volume above 35 % of the total LV myocardial volume is diagnostic for LVNC with high specificity. Also, the apex/C and NC/septum ratios could be useful as supplementary diagnostic criteria.

Fractal analysis of left ventricular trabeculations is associated with impaired myocardial deformation in healthy Chinese

“…Its high spatial resolution allows for better differentiation between non-compacted and compacted layers of myocardium, compared to two-dimensional (2D) echocardiography and computed tomography (CT) imaging. Though current CMR-based diagnostic criteria (Additional file 1 : Table S1) are mostly based on the ratio between non-compacted and compacted myocardium/layer in terms of thickness [ 18 , 19 ], mass [ 20 ] or volume [ 21 ], recent approaches and tools based on fractal geometry [ 22 , 23 ] to quantify trabeculation complexity have been developed but have yet to be applied in mainstream clinical practice. Due to the wide spectrum of normal variation in trabeculation, criteria for LVNC cardiomyopathy have been developed but these are based on small sample sizes and may result in over-diagnoses [ 14 , 24 ].…”

Supplementary Diagnostic Landmarks of Left Ventricular Non-Compaction on Magnetic Resonance Imaging

“…Clinically, even more significant differences were found in the cases with clinical suspicion of LVNC, pointing MaxMinEDDR as a diagnostic tool to make clear distinction between the cases with LVNC and those that are clinically suspicious. 30 The latter was also confirmed by a lack of significant correlations between suspicious LVNC and MaxMinEDDR, as well as its constituents.…”

Influence of observer-dependency on left ventricular hypertrabeculation mass measurement and its relationship with left ventricular volume and ejection fraction – comparison between manual and semiautomatic CMR image analysis methods

“…LVNC revealed in the recent studies and its clinical similarity to nDCM in terms of genetics, morphology, and clinics, often lead cardiologists and radiologists to perceive LVNC as a form of nDCM [4,16]. These doubts and questions have prompted attempts to establish the criteria of the LVNC diagnosis [17,18], which are most commonly based on Petersen's or Jacquier's observations [4,8,6]. According to Petersen et al, LVNC can be recognized if the criterion of the noncompacted to compacted layer width ratio > 2.3 is fulfilled in at least one LV segment.…”