Abstract 13487: Refinement of Echocardiographic Criteria for Left Ventricular Noncompaction
Introduction: The echocardiographic criteria for left ventricular noncompaction (NCCM) are still controversial Resultsing in over- and underdiagnosis. Cooperation between experts from different echocardiographic laboratories may contribute to uniformly accepted criteria.
Methods: Echocardiograms from 115 patients proposed for inclusion into the ALKK – NCCM- registry were jointly reviewed by 3 experts with 16–25 years experience with NCCM. NCCM was diagnosed if >3 trabeculations were visible apically from the insertion of the papillary muscles and if the myocardium showed an outer compacted and an inner noncompacted layer. Reasons for exclusion were documented.
Results: Overall, 115 cases were reviewed. Eleven patients were excluded due to <4 trabeculations(n=5), lack of a 2-layered myocardial structure(n=1) and poor image quality(n=5). Consensus was achieved that the number of trabeculations and the perfusion of the intertrabecular recesses could be best visualized at end-diastole, and the 2-layered myocardium at end-systole. Helpful views were the parasternal short-axis view at the apical level for counting the number of trabeculations, and an atypical apical 2-chamber view with visualization of the coronary sinus to assess the 2-layered myocardium and to differentiate midventricular NCCM from papillary muscles. Consensus was achieved that measurement of the thickness of the myocardial layers was not feasible, because standards for measurements were impossible to achieve. Thus, the mere demonstration of a 2-layered myocardium seemed sufficient and no ratio was calculated.
Conclusions: When diagnosing NCCM, end-systolic as well as end-diastolic frames have to be considered. An increased number of trabeculations as well as a 2-layered myocardium should be present. Atypical views should be added if conventional views fail to be diagnostic.
- © 2010 by American Heart Association, Inc.