Reversible De Novo Left Ventricular Trabeculations in Pregnant Women: Implications for the Diagnosis of Left Ventricular Non-Compaction in Low Risk Populations
Background—Patients with heart failure and chronic anemia frequently demonstrate left ventricular (LV) trabeculations which may be compatible with the diagnosis of left ventricular non-compaction (LVNC). We utilized the pregnancy model, which is characterized by reversible increase in cardiac preload and other changes in cardiac function, to assess the development of de novo LV trabeculations in women with morphologically normal hearts.
Methods and Results—102 primigravida pregnant women were evaluated longitudinally with a series of echocardiograms in the first trimester, third trimester and post-partum. Echocardiograms were analysed according to established guidelines. Increased LV trabeculations and the presence of LVNC were based on established criteria. Pregnancy was associated with an increased heart rate, stroke volume and cardiac output as well as increased LV volume and mass. During pregnancy 26 (25.4%) women developed increased trabeculations. 8 women showed sufficient trabeculations to fulfill both Chin and Jenni criteria for LVNC. During the post-partum follow-up period of 24±3 months, 19 (73%) women demonstrated complete resolution of trabeculations and 5 showed marked reduction in the trabeculated layer.
Conclusions—Pregnancy induces de novo LV trabeculations in a significant proportion of women. The results suggest that left ventricular trabeculations occur in response to increased LV loading conditions or other physiologic responses to pregnancy and are not specific for LVNC. These factors should be considered when assessing individuals with LV trabeculations outside the context of symptoms of heart failure or familial cardiomyopathy.
- Left Ventricular Trabeculations
- left ventricle
- left ventricular noncompaction
- longitudinal cohort study
- Received January 8, 2014.
- Revision received May 27, 2014.
- Accepted May 30, 2014.