Comparison of Imaging Modalities for Left Ventricular Noncompaction Morphology

Left ventricular noncompaction (LVNC) is characterized by excessive trabeculation, which may impair left ventricular function over time. While cardiac magnetic resonance imaging (CMR) is considered the gold standard for evaluating LV morphology, the optimal modality for follow-up remains uncertain. This study aimed to assess the correlation and agreement among two-dimensional transthoracic echocardiography (2D_TTE), three-dimensional transthoracic echocardiography (3D_TTE), and CMR by comparing volumetric and strain parameters in LVNC patients and healthy individuals. Thirty-eight LVNC subjects with preserved ejection fraction and thirty-four healthy controls underwent all three imaging modalities. Indexed end-diastolic, end-systolic, and stroke volumes, ejection fraction, and global longitudinal and circumferential strains were evaluated using Pearson correlation and Bland-Altman analysis. In the healthy group, volumetric parameters showed strong correlation and good agreement across modalities, particularly between 3D_TTE and CMR. In contrast, agreement in the LVNC group was moderate, with lower correlation and higher percentage errors, especially for strain parameters. Functional data exhibited weak or no correlation, regardless of group. These findings suggest that while echocardiography may be suitable for volumetric follow-up in LVNC after baseline CMR, deformation parameters are not interchangeable between modalities, likely due to trabecular interference. Further studies are warranted to validate modality-specific strain assessment in hypertrabeculated hearts.