Echocardiographic quantification of regional deformation helps to distinguish isolated left ventricular non‐compaction from dilated cardiomyopathy

Abstract

AimsPronounced trabeculation is presented in both left ventricular non-compaction (LVNC) and dilated cardiomyopathy (DCM), which sometimes makes the differentiation difficult. We hypothesized that echocardiographic deformation analysis would help to differentiate these two cardiomyopathies. Methods and resultsWe investigated 15 patients with LVNC (9 males; 42 + 9 years), 15 age-and gender-matched DCM patients, and 15 healthy controls. The echocardiographic diagnosis of LVNC was confirmed by magnetic resonance imaging. In all subjects standard echocardiography and tissue Doppler imaging (TDI) to study regional LV deformation were carried out. No statistical difference was observed in standard echocardiographic parameters between LVNC and DCM patients. Compared with controls, both patient groups showed significantly reduced annular displacements (septal: controls 14 + 2 mm vs. DCM 6 + 3 mm vs. LVNC 7 + 3 mm) and reduced strain values of the LV segments. A characteristic deformation pattern with significantly higher values in the LV base compared with the apex was observed in patients with LVNC by deformation measurements with TDI. This gradient was found particularly in the lateral and inferior wall but spared the anteroseptal wall; non-compaction was not found in basal segments throughout the ventricle and also spared the anteroseptal midventricular wall. In DCM the strain and strain rate values were homogeneously reduced in all LV segments. ConclusionA special regional deformation pattern (preserved deformation in basal segments of LVNC) seems to be of major diagnostic help for the definite differential diagnosis of LVNC and DCM.--

Myocardial deformation pattern in left ventricular non-compaction: Comparison with dilated cardiomyopathy

“…In our experience, none of the standard LV systolic dysfunction parameters was able to discriminate a DCM from a LVNC. Previous studies tried to find useful echocardiographic discrepancies and demonstrated the same results [18]. According to Tufekcioglu et al, we found that most of the conventional echocardiography findings for the two conditions were statistically similar [19].…”

Isolated left ventricular non-compaction controversies in diagnostic criteria, adverse outcomes and management

“…Patient with LVNC suggested on 2D echocardiography (B1), demonstrated reduction in longitudinal strain at the site of greatest trabeculation (apex) on a 2D speckle-tracking polar map (B2) and absent LV torsion as a result of unidirectional rotation of the base and apex (B3) (normally, basal rotation is clockwise while apical rotation is counter-clockwise). The apical versus base strain difference has been previously validated with tissue Doppler-based strain analysis 33. We have demonstrated the same with speckle tracking-based strain in panel B2.…”

“…Recently, myocardial strain values have been shown to be abnormal in patients with LVNC even in the context of preserved systolic function32 (see supplement movie 1, figure A) suggesting subclinical LV dysfunction. Also, a pattern of relative basal sparing (ie, higher proportional reduction in strain in the apex compared with the base) has been shown to differentiate LVNC from dilated cardiomyopathy33 (figure 2B1,B2). In addition, more advanced mechanical parameters, such as basal and apical twist both occurring in the same direction, have also been shown to help differentiate LVNC from DCM34 (figure 2B3).…”

Double orifice mitral valve combined with left ventricular noncompaction in a child with Sotos syndrome

“…Although several case reports have been published of this syndrome complicated with LVNC or DOMV alone, the combination of both complications has not been reported previously [3,4]. LVNC is characterized by the persistence of embryonic myocardial morphology and thickening of LV wall in the apical segments, due to noncompacted myocardium with prominent trabeculations [5]. LVNC is associated with heterogeneous genetic background, although the presence of any correlation with Sotos syndrome has not been firmly established [3,6].…”

“…Patients with Sotos syndrome should be screened for mitral valve anomaly, subvalvular apparatuses, and LV myocardial abnormality and function due to the reported wide variability of cardiac symptoms [5,6].…”