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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
Summary
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.
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