Left Ventricular Noncompaction in Advanced Heart Failure With an Anomalous Coronary Artery: A Case Report

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Heart Failure Research

Background:

• Left ventricular noncompaction (LVNC) is a rare congenital cardiomyopathy characterized by abnormal myocardial development.
• While traditionally considered congenital, increasing evidence suggests acquired forms may arise from adverse myocardial remodeling.

Observation:

• A 77-year-old male with chronic atrial fibrillation and nonischemic cardiomyopathy presented with severe LVNC.
• Diagnosis was confirmed via echocardiography and cardiac MRI, showing a noncompacted-to-compacted ratio >2.3 and ejection fraction <20%.
• Angiography revealed nonobstructive coronary disease and an anomalous left circumflex artery, emphasizing the need for comprehensive imaging.

Findings:

• This case demonstrates a late-onset presentation of LVNC in an elderly patient without a family history.
• The findings suggest that hemodynamic stressors and pre-existing conditions like cardiomyopathy can contribute to LVNC development.
• Multimodality imaging is crucial for detecting coexisting cardiac anomalies.

Implications:

• The study expands the recognized demographic for LVNC, including older adults with acquired risk factors.
• It underscores the importance of considering acquired causes and utilizing advanced imaging techniques for LVNC diagnosis.
• A comprehensive management approach, including rate control, heart failure therapy, and device implantation, is vital for optimizing outcomes in elderly patients with LVNC.