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European Heart Journal Advance Access originally published online on November 9, 2007
European Heart Journal 2008 29(1):89-95; doi:10.1093/eurheartj/ehm481
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

Diagnosis of left-ventricular non-compaction in patients with left-ventricular systolic dysfunction: time for a reappraisal of diagnostic criteria?

Sanjay K. Kohli1, Antonios A. Pantazis1, Jaymin S. Shah1, Benjamin Adeyemi2, Gordon Jackson3, William J. McKenna1, Sanjay Sharma3 and Perry M. Elliott1,*

1 The Heart Hospital, University College, 16–18 Westmoreland Street, W1G 8PH London, UK
2 North Middlesex Hospital, London, UK
3 University Hospital Lewisham, London, UK

Received 9 January 2007; revised 24 September 2007; accepted 27 September 2007; online publish-ahead-of-print 9 November 2007.

* Corresponding author. Tel: +44 207 573 8888/ext. 4801, Fax: +44 207 573 8838. Email: pelliott{at}doctors.org.uk

See page 10 for the editorial comment on this article (doi:10.1093/eurheartj/ehm536)

Aims: Left-ventricular non-compaction (LVNC) is characterized by excessive and prominent left-ventricular (LV) trabeculations and may be associated with systolic dysfunction in advanced disease. We sought to determine the proportion of patients fulfilling LVNC criteria in an adult population referred to a heart failure clinic using current diagnostic criteria.

Methods and results: One hundred and ninety-nine patients [age 63.5 ± 15.9 years, 124 (62.3%) males] with LV systolic impairment were studied. All underwent clinical examination, electrocardiography, and 2-D echocardiography. The number of patients fulfilling diagnostic criteria for LVNC was retrospectively determined using three published definitions. Results were compared with 60 prospectively evaluated normal controls (age 35.7 ± 13.5 years; 31 males, 30 blacks). Forty-seven patients (23.6%) fulfilled one or more echocardiographic definitions for LVNC. Patients fulfilling LVNC criteria were younger (P = 0.002), had larger LV end-diastolic dimension (P < 0.001), and smaller left atrial size (P = 0.01). LVNC was more common in black individuals (35.5 vs. 16.2%, P = 0.003). Five controls (four blacks) fulfilled one or more LVNC criteria.

Conclusions: This study demonstrates an unexpectedly high percentage of patients with heart failure fulfilling current echocardiographic criteria for LVNC. This might be explained by a hitherto underestimated cause of heart failure, but the comparison with controls suggests that current diagnostic criteria are too sensitive, particularly in black individuals.

Key Words: Left ventricular non-compaction • Echocardiography • Diagnosis • Race


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