[Gallop in the Routineergometrie: Only Chore or Diagnostic Challenge?]

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Genetics

Background:

• Noncompaction cardiomyopathy (NCCM) is a rare congenital heart disease characterized by excessive myocardial trabeculation.
• Patients often present with heart failure, arrhythmias, or thromboembolic events, with sudden cardiac death being a leading cause.

Observation:

• A 47-year-old sportsman with good physical performance was found to have polymorphic ventricular extrasystoles (VES) during routine ergometry.
• Resting ECG showed VES, and long-term ECG recorded up to 100 VES per hour.
• Echocardiography revealed prominent apical trabeculae in the left ventricle and lower right ventricle.
• Cardio-MRT showed lateral and apical wall dilation with increased trabecularization but no late enhancement.

Findings:

• Diagnosis of a mild, asymptomatic form of noncompaction cardiomyopathy (NCCM).
• Treatment includes guideline-based cardiac insufficiency management and ICD-CRT therapy.
• Ramipril was recommended, and transvenous ICD implantation was deferred due to the unavailability of subcutaneous ICD systems at the time.

Implications:

• Family screening and genotyping are recommended for affected individuals.
• The study suggests that asymptomatic or borderline findings of NCCM can exist, even in athletes.
• Further research is needed to investigate the potential protective influence of sports activities on cardiovascular adaptations in NCCM patients.