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Left Ventricular Hypertrabeculation: Historical Evolution, Diagnostic Pitfalls, and a Pragmatic Clinical Approach

Alessandro Parodi1, Marika Martini1, Annagrazia Cecere1

  • 1Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua Medical School, 35128 Padua, Italy.

Reviews in Cardiovascular Medicine
|June 4, 2026
PubMed

Insights

Left ventricular hypertrabeculation (LVHT) is a myocardial feature now viewed as a trait, not a distinct cardiomyopathy. Further research is needed to clarify its associations, mechanisms, and improve diagnostic accuracy.

Area of Science:

  • Cardiology
  • Genetics
  • Molecular Biology

Background:

  • Left ventricular hypertrabeculation (LVHT), formerly left ventricular non-compaction (LVNC), has evolving diagnostic criteria.
  • Current guidelines classify LVHT as a myocardial trait rather than a primary genetic cardiomyopathy.
  • Incomplete understanding persists regarding LVHT's pathophysiology, genetic basis, and associations with other syndromes.

Purpose of the Study:

  • To review the diagnostic criteria, pathophysiology, and management strategies for LVHT.
  • To address the diagnostic uncertainties and clinical challenges associated with LVHT.
  • To propose a practical clinical approach for managing patients with LVHT.

Main Methods:

  • Systematic review of existing literature on LVHT.
  • Analysis of diagnostic criteria and classification changes over time.
  • Examination of pathophysiological mechanisms and genetic underpinnings.
  • Evaluation of current management guidelines and clinical data.

Main Results:

  • LVHT recognition and classification have fluctuated, shifting from a cardiomyopathy to a trait.
  • Data linking LVHT to other syndromes and its molecular mechanisms remain inconclusive.
  • Accurate diagnosis is crucial to avoid over- or underdiagnosis and manage uncertainties.

Conclusions:

  • LVHT is a complex myocardial feature requiring further investigation.
  • Standardized data collection is essential for improved diagnostic accuracy and management.
  • A practical approach is proposed to aid clinicians in diagnosing and managing LVHT.

Keywords:
cardiomyopathyhypertrabeculationleft ventricular hypertrabeculationleft ventricular non-compactionmanagementphenotypes

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