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

Abstract

PurposeDiagnostic criteria for left ventricular non-compaction (LVNC) are still a matter of dispute. The aim of our present study was to test the diagnostic value of two novel diagnostic cardiac magnetic resonance (CMR) parameters: proof of non-compact (NC) myocardium blood flow using T2 sequences and changes in geometry of the left ventricle.Materials and MethodsThe study included cases with LVNC and controls, from a data base formed in a period of 3.5 years (n=1890 exams), in which CMR protocol included T2 sequences. Measurement of perpendicular maximal and minimal end diastolic dimensions in the region with NC myocardium from short axis plane was recorded, and calculated as a ratio (MaxMinEDDR), while flow through trabecula was proven by intracavital T2-weighted hyperintensity (ICT2HI). LVNC diagnosis met the following three criteria: thickening of compact (C) layer, NC:C>2.3:1 and NC>20%LV.ResultsThe study included 200 patients; 71 with LVNC (35.5%; i.e., 3.76% of CMRs) and 129 (64.5%) controls. MaxMinEDDR in patients with LVNC was significantly different from that in controls (1.17±0.08 vs. 1.06±0.04, respectively; p<0.001). MaxMinEDDR >1.10 had sensitivity of 91.6% [95% confidence intervals (CI) 82.5–96.8], specificity of 85.3% (95% CI 78.0–90.0), and area under curve (AUC) 0.919 (95% CI 0.872–0.953; p<0.001) for LVNC. Existence of ICT2HI had sensitivity of 100.0% (95% CI 94.9–100.0), specificity of 91.5% (95% CI 85.3–95.7), and AUC 0.957 (95% CI 0.919–0.981; p<0.001) for LVNC.ConclusionTwo additional diagnostic parameters for LVNC were identified in this study. ICT2HI and geometric eccentricity of the ventricle both had relatively high sensitivity and specificity for diagnosing LVNC.

Diagnostic accuracy of noncompacted-to-compacted wall ratio criteria on CMRI for the diagnosis of left ventricular noncompaction

“…Notwithstanding this limitation, this cut-off value gained popularity in clinical applications while also had been subjected to considerable criticism by many authors. The study by Boban et al, supported the reliability of the initial criteria proposed by Petersen et al, [12,18] and also suggested measuring noncompacted myocardium blood flow using T2 sequences and geometric eccentricity of the ventricle as supplementary diagnostic markers on CMRI for the diagnosis of LVNC. Boban [18].…”

“…The study by Boban et al, supported the reliability of the initial criteria proposed by Petersen et al, [12,18] and also suggested measuring noncompacted myocardium blood flow using T2 sequences and geometric eccentricity of the ventricle as supplementary diagnostic markers on CMRI for the diagnosis of LVNC. Boban [18]. In their work, the cut-off threshold value revealed equal sensitivity (97.2%) and comparably higher specificity (96.3%) compared with the present study.…”

Overlapping Phenotypes and Degree of Ventricular Dilatation Are Associated with Severity of Systolic Impairment and Late Gadolinium Enhancement in Non-Ischemic Cardiomyopathies

“…Guidelines-based criteria were used to determine the primary type of cardiomyopathy, while combined characteristics of several cardiomyopathies types were classified as secondarily overlapping phenotype [ 21 ]. Diagnosis of LVNC was based on presence of thinned solid myocardium ≤0.5 cm, NC/C ratio ≥2.3: 1, and proportion of non-compact myocardium being greater than 20%, as we previously described [ 22 ]. Marginal cases with NC ≥15% but with NC/C ≥2.3: 1 and those with HCM and end-diastolic thickness ≥1.40 cm were included in the group of overlapping phenotypes.…”

Ischemic Stroke Secondary to Left Ventricular Noncompaction

“…Peterson et al suggests that a ration of noncom-pacted/compacted myocardium of > 2.3 in diastole is highly suggestive of LVNC [14]. Boban et al [31] further evaluated the benefit of cardiac MRI in the diagnosis of LVNC and verified its high specificity and sensitivity. Another advantage of cardiac MRI is the benefit of imaging the apex and the use of enhancement to evaluate fibrosis [32,33] and superior visualization of left ventricular thrombi [33].…”