Abstract 698: Late Enhancement in Isolated Noncompaction Left Ventricle is Related to Repetitive Ventricular Arrhythmias
Isolated noncompaction left ventricle (INLV), an unclassified cardiomyopathy, is associated to an ominous prognosis due to arrhythmias, embolism and heart failure. We hypothesized that, in patients with INLV, the presence of late enhancement (LE), assessed by cardiovascular magnetic resonance (CMR) could be related to repetitive ventricular arrhythmias, which are determinants of sudden death.
Methods: 22 consecutive patients (pts), aged 35±11 years-old, 11 men) with INLV, were included. Diagnosis was established by echocardiography and CMR using accepted criteria. All underwent complete CMR LV assessment using a 17-segments model:
SSFP short-axis LV volumes and ejection fraction;
SSFP 2, 3, 4-chambers for noncompaction segmental distribution;
LV segmental LE (segmented inversion-recovery fast gradient-echo sequence, 10–15 mn after 0.2mmol/kg of Gd-DTP);
the number of segments with LE was assessed. A 24 hours-Holter monitoring was obtained in less than two-weeks interval and the number of repetitive ventricular arrhythmias was assessed (pairs, triplets, ventricular tachycardia).
Results: Non-compaction was present in 212 segments, involving mainly the inferior, posterior and lateral walls, but all walls were involved in different patients. LE was detected in 242 segments (8±2 per patient), present in all non-compaction segments and in 30 morphologically normal segments. Fibrosis was visible in the non-compacted layer (all segments) and in the more internal layer of the compacted myocardium (161 segments, 67%). LV end-diastolic volume was 128±22ml/m2) and there was LV dilatation and reduced ejection fraction in 14 patients. Repetitive ventricular arrhythmias were present in all patients, varying from 3 to 155 episodes in the Holter monitoring. There was a correlation between the number of ventricular arrhythmias the number of non-compaction segments (r=0.43, 0,04) and the number of LE present segments (r=0.65, p=0.001). No correlation was found with LV end-diastolic volumes or ejection fraction.
Conclusions: CMR late enhancement is a frequent finding in isolated non-compaction LV and is significantly associated to complex ventricular arrhythmias. Further study should address the prognostic meaning of LE in this condition