How should we interpret excessive left ventricular trabeculation? Update on controversies from the cardiac imaging...

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Genetics

Background:

• Established criteria exist for diagnosing excessive myocardial trabeculation (ET) of the left ventricle.
• ET is observed in healthy individuals and those with cardiomyopathies, linked to conditions affecting preload/afterload and systemic diseases.
• Current evidence refutes an embryologic origin, rendering "ventricular non-compaction" an outdated term, and its classification as an independent cardiomyopathy is discouraged.

Purpose of the Study:

• To provide a comprehensive review of current knowledge on myocardial trabeculation.
• To clarify diagnostic criteria, prognostic implications, and associations with other conditions, differentiating between adult and pediatric populations.
• To discuss potential adverse cardiovascular events and emphasize differential diagnosis for myocardial ET.

Main Methods:

• Review of existing scientific evidence and diagnostic criteria for myocardial trabeculation.
• Integration of imaging findings with clinical and genetic information.
• Critical appraisal of current knowledge from imaging and clinical perspectives.

Main Results:

• Excessive myocardial trabeculation (ET) is not necessarily pathological and can be a normal phenotypic trait.
• Hemodynamic stressors may influence ET development, but its precise cause and clinical significance remain under investigation.
• Accurate prognostic stratification requires combining ET imaging findings with clinical and genetic data.

Conclusions:

• The clinical relevance and management implications of ET require further clarification.
• Distinguishing ET from mimicking conditions through differential diagnosis is crucial for accurate diagnosis and patient management.
• A multidisciplinary approach integrating imaging, clinical context, and genetic information is essential for understanding and managing ET.