Decreased Deformation in Asymptomatic Children with Isolated Left Ventricular Non-compaction and Normal Ejection Fraction

Abstract

Echocardiography is the mainstay of screening and disease surveillance in isolated left ventricular non-compaction (iLVNC). The aim of our study is to determine the early regional and global myocardial functional changes and whether the myocardial changes that cannot be detected by conventional echocardiography could be detected by tissue Doppler imaging (TDI) or two-dimensional speckle-tracking echocardiography (STE) in iLVNC cases without symptoms. Longitudinal and circumferential strain (S) and strain rates (SR) as determined by STE in 20 children aged 12.1 ± 3.3 years was compared with those in 20 controls. All children underwent echocardiographic assessment using two-dimensional, tissue Doppler and speckle-tracking echocardiography. iLVNC patients who had normal systolic function by ejection and shortening fractions were included in this study. According to the TDI in all three segments [the non-compacted (NC), neighboring NC (NNC) and compacted (C) segments], isovolumic contraction time, isovolumic relaxation time and myocardial performance index values were significantly higher, while ejection time were significantly lower in the iLVNC group. According to STE in two segments (NC and NNC-segments) longitudinal S and SR values and also circumferential S and SR values were significantly lower in the iLVNC group compared with the control group; whereas, in the global measurements both longitudinal and circumferential S and SR values in all three segments were significantly lower in the iLVNC group compared with the control group. We believe that TDI and STE that evaluates myocardial deformation can be used for the detection of early myocardial dysfunction in the iLVNC patients who are subclinical and whose left ventricular functions were detected as normal by conventional methods with normal ejection and shortening fractions.

Left ventricular noncompaction: a distinct cardiomyopathy or a composite anatomical syndrome?

“…Глобальная сократительная функция ЛЖ и гемодинамика могут быть длительное время нормальными у пациентов с НКЛЖ. Для раннего выявления локальной сократительной дисфункции миокарда целесообразно проведение 2-мерной ЭхоКГ с тканевым слежением (speckle-tracking) изображений, что позволяет обнаружить локальное снижение сократимости миокарда у пациентов с НКЛЖ при нормальной ФВ ЛЖ [32,33]. Актуален поиск новых критериев, индексов продольной и циркулярной деформации миокарда, отражающих раннюю сократительную дисфункцию ЛЖ у пациентов с НКЛЖ.…”

Right atrial deformation analysis in isolated left ventricular noncompaction – insights from the three-dimensional speckle tracking echocardiographic MAGYAR-Path Study

“…Ari et al found that tissue Doppler imaging-and STE-derived myocardial deformation can be used for the detection of early myocardial dysfunction in patients with subclinical ILVNC whose LV function was classified as normal by conventional methods, with normal ejection and shortening fraction. 13 As well as the abovementioned alterations in quantitative features of LV wall motion abnormalities, LV 'rigid body rotation', the near absence of LV twist, was found to be a frequent phenomenon in ILVNC as well. 15,16 Besides these LV studies, atrial morphology and function in ILVNC patients have been examined in very few studies.…”

Noncompaction cardiomyopathy: The role of advanced multimodality imaging techniques in diagnosis and assessment

“…Importantly, lateral mitral early diastolic velocity has been found to predict cardiac death or transplantation at 1 year after diagnosis Significantly reduced annular displacements (septal) in patients with NCCM Longer IVRT (isovolumic relaxation time) and IVCT (isovolumic contraction time) and shorter LV ejection time noted in NCCM. Myocardial performance index [assesses both systolic and diastolic function] was also affected (lower in NCCM) …”

“…Lower strain and strain rates in the NC and neighboring segments by speckletracking-basedstrainanalysisandsignificantimpairmentof straininallmyocardialsegments(tissueDoppler-basedstrain) 52 Reducedsystolicstrain…”

“…function]wasalsoaffected(lowerinNCCM). 52 The advanced echocardiographic techniques (RT3DE and strain analysis-2D-TDI-based and STE±3D STE) described above allow for more precise characterization and identification of subclinical manifestations of NCCM, although more evidence-based data are warranted.…”