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Updated: Dec 13, 2025
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Prevalence and significance of isolated left ventricular non-compaction phenotype in normal black Africans using
Samantha Nel1, Bijoy K Khandheria2, Elena Libhaber1
1Division of Cardiology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, R68 Old Potchefstroom Road, PO Bertsham, Johannesburg 2013, South Africa.
Insights
Hypertrabeculation, a heart condition, can be a normal variant in black Africans. Comprehensive criteria are needed to differentiate it from left ventricular noncompaction (LVNC), as these individuals maintain normal heart function.
Area of Science:
- Cardiology
- Genetics
- Imaging
Background:
- Hypertrabeculation is often considered pathological only when accompanied by left ventricular (LV) dysfunction, dilatation, or specific genetic factors.
- This association is less clear in Black populations, where hypertrabeculation and LV hypertrophy are more prevalent.
- The study aimed to clarify the frequency of hypertrabeculation and isolated LV noncompaction (ILVNC) in healthy Black Africans.
Purpose of the Study:
- To determine the prevalence of the hypertrabeculation/ILVNC phenotype in a cohort of normal Black Africans.
- To assess left ventricular (LV) function using sensitive measures of deformation and twist in individuals with hypertrabeculation.
- To differentiate normal variants from pathological LVNC using established criteria.
Main Methods:
- Recruited 253 healthy Black African volunteers meeting strict inclusion/exclusion criteria.
- Evaluated trabeculation frequency and distribution using echocardiography.
- Assessed LV function via strain and twist parameters, and applied established ILVNC criteria (Stollberger, Jenni, Milwaukee, Baragwanath).
Main Results:
- Trabeculations were observed in 4.74% of participants; 1.2% had ≥4 LV trabeculations, predominantly at the LV apex.
- Individuals with trabeculations were younger males with larger LV end-diastolic/end-systolic dimensions and greater lateral e' (early diastolic strain rate).
- Only 0.8% met Stollberger criteria, and none met other criteria; all subjects exhibited normal LV rotation and twist.
Conclusions:
- Hypertrabeculation can be a normal variant in Black Africans, not necessarily indicating pathology.
- Comprehensive ILVNC criteria are crucial for distinguishing normal variants from pathological LVNC.
- Individuals with hypertrabeculation as a normal variant demonstrate preserved LV function, rotation, and twist.
Background:
Several large, prospective screening studies of predominantly Caucasian patients have suggested that hypertrabeculation may not necessarily be pathologic unless there is concomitant left ventricular (LV) dysfunction, LV dilatation, history of arrhythmia, family history, or characteristic gene mutations. This conundrum may be magnified in blacks, in whom hypertrabeculation and LV hypertrophy is more common. We therefore investigated the frequency of hypertrabeculation/isolated LV noncompaction (ILVNC) phenotype in normal black Africans and evaluated LV function using sensitive measures of deformation and twist.
Methods:
Two hundred and fifty-three volunteers were recruited and evaluated according to strict inclusion and exclusion criteria. Their mean age was 36.3 ± 12.2 years.
Results:
Trabeculations were found in 12 (4.74%) participants. Three (1.2%) subjects had ≥ 4 LV trabeculations. The LV apex was the most common anatomical site for the location of trabeculations. Subjects with trabeculations were more likely to be males of a younger age, and had greater LV end-diastolic and end-systolic parameters and lateral e'. However, 0.8% of the population fulfilled the Stollberger criteria, and none fulfilled the Jenni, Milwaukee, or Baragwanath criteria. All subjects in this study had normal rotation patterns with no differences in rotational parameters or net twist.
Conclusions:
Trabeculations may be found as a normal variant in black Africans. Assessing trabeculations alone may infer ILVNC; however, utilizing the more comprehensive ILVNC criteria enables differentiation of a possible LVNC phenotype. Normal individuals with hypertrabeculation have normal LV function and normal rotation patterns, with no differences in rotational parameters or net twist.
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