Left Ventricular Noncompaction Cardiomyopathy in an Elderly Patient: A Case Report

Left ventricular noncompaction is a rare cardiomyopathy, often underrecognized in older adults, characterized by prominent myocardial trabeculations and deep intertrabecular recesses. These structural abnormalities can lead to heart failure, arrhythmias, and thromboembolic events. We report the case of an 85-year-old woman with a history of heart failure with preserved ejection fraction and atrial fibrillation who presented with chest pain and dyspnea. Her electrocardiogram (ECG) revealed new diffuse T-wave inversions. Coronary angiography showed no obstructive disease. Transthoracic echocardiography demonstrated features consistent with left ventricular noncompaction cardiomyopathy (LVNC), including a noncompacted-to-compacted ratio greater than 2:1, along with a reduced left ventricular ejection fraction (LVEF) of 25-30% (normal LVEF >55%). Cardiac MRI was recommended to further characterize the myocardial structure, but the patient declined. She was managed with guideline-directed medical therapy for heart failure and anticoagulation and discharged with a wearable defibrillator. While LVNC is congenital, it may remain undiagnosed until later in life, particularly when symptoms arise due to progressive systolic dysfunction. This case illustrates the delayed diagnosis of a congenital condition rather than a late-onset disease. Greater awareness of LVNC and use of advanced imaging modalities, such as cardiac MRI, are important to improve recognition and management in older adults.