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Published on: May 24, 2021
Left ventricular non-compaction: insights from cardiovascular magnetic resonance imaging
Steffen E Petersen1, Joseph B Selvanayagam, Frank Wiesmann
1University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom.
Insights
Cardiovascular magnetic resonance (CMR) imaging accurately diagnoses left ventricular non-compaction (LVNC). A non-compacted to compacted myocardium (NC/C) ratio greater than 2.3 in diastole effectively distinguishes pathological LVNC from other conditions.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Accuracy
Background:
- Left ventricular non-compaction (LVNC) involves an abnormal myocardial layer.
- Cardiovascular magnetic resonance (CMR) excels at imaging the left ventricle, especially the apex where echocardiography struggles.
Purpose of the Study:
- To evaluate CMR's accuracy in differentiating pathological LVNC from normal variants and other cardiomyopathies.
- To test the hypothesis that the non-compacted to compacted myocardium (NC/C) ratio can distinguish pathological LVNC.
Main Methods:
- Analysis of cine CMR images from healthy volunteers, athletes, and patients with various cardiomyopathies and hypertrophic conditions.
- Inclusion of patients with pre-existing LVNC diagnoses confirmed by additional features.
Main Results:
- Non-compaction patterns were frequently observed across all groups, predominantly in apical and lateral segments.
- A NC/C ratio exceeding 2.3 in diastole demonstrated high diagnostic performance: 86% sensitivity, 99% specificity.
Conclusions:
- CMR imaging, utilizing the NC/C ratio in diastole, provides accurate diagnosis of left ventricular non-compaction.
- This method effectively distinguishes pathological LVNC from other cardiac conditions.
Objectives:
We aimed to test the diagnostic accuracy of cardiovascular magnetic resonance (CMR) imaging in distinguishing pathological left ventricular non-compaction (LVNC) from lesser degrees of trabecular layering seen in healthy volunteers and, in those with cardiomyopathies and concentric left ventricular hypertrophy, potential differential diagnoses. We hypothesized that pathological trabeculation could be distinguished by determining the ratio of non-compacted to compacted myocardium (NC/C ratio).
Background:
Left ventricular non-compaction is characterized by a non-compacted myocardial layer in the left ventricle. Cardiovascular magnetic resonance images this layer with unprecedented quality, particularly in the ventricular apex, where echocardiography has inherent difficulties.
Methods:
We analyzed magnetic resonance cine images, using the 17-segment model in 45 healthy volunteers, 25 athletes, 39 patients with hypertrophic cardiomyopathy and 14 with dilated cardiomyopathy, 17 with hypertensive heart disease, and 30 with aortic stenosis, as well as images from 7 patients previously diagnosed with LVNC whose diagnoses were supported by additional features.
Results:
Areas of non-compaction were common and occurred more frequently in all groups studied in apical and lateral, rather than in basal or septal, segments. A NC/C ratio of >2.3 in diastole distinguished pathological non-compaction, with values for sensitivity, specificity, and positive and negative predictions of 86%, 99%, 75%, and 99%, respectively.
Conclusions:
Left ventricular non-compaction is diagnosed accurately with CMR using the NC/C ratio in diastole.
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