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Number 08-07 Left Ventricular Trabeculae, Non-Compaction and DCM

Case from: E Bergen, S Javaheri, G York: Brooke Army Medical Center, Fort Sam Houston, Texas

History: 18 Y/O male presented with dyspnea and palpitations. His father had died suddenly at age 32.

Echocardiogram: Global Hypokinesis and hyper-trabeculation suggestive of non-compaction.

CMR Referral: To establish a diagnosis of left ventricular non-compaction (LVNC).

CMR Interpretation: Dilated hypokinetic left ventricle. Ratio of non-compacted to compacted myocardium at end diastole in the midventricle was 2:1. The hyper-trabeculation was present in anterolateral, lateral, inferolateral, and apical walls sparing the septum.

CMR Perspective: The trabecular architecture was better appreciated with CMR leading to a proposed diagnosis of LVNC cardiomyopathy. Although often seen in LVNC, LGE was not observed in this patient.

Clinical Course: The treatement initiated was for DCM and heart failure– although with a lower threshold for warfarin. During his initial evaluation multiple episodes of non-sustained ventricular tachycardia were documented. An AICD was inserted.

References: (1) Virmani R et al; Hum Pathol. 2005;36(4):403-11 (2) Jenni R; et al Heart 2007;93;11-15 (3) Petersen SE et al. J Am Coll Cardiol. 2005 Jul 5;46(1):101-5.

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