Usefulness of Cardiac Magnetic Resonance Imaging in Left Ventricular Non-Compaction Cardiomyopathy

We have read with great interest the paper published recently in your journal by Habib et al.1 about isolated left ventricular non-compaction in adults. As the authors say, the genetic and clinical features, prognosis and characterization of this fascinating entity remain incompletely understood and the subject of interesting debate in the scientific community.2 As stated by the authors, difficulties commence with the diagnostic criteria, as different timings of measurement, at systole or diastole, have been proposed. In addition even for experts, making a final diagnosis can be difficult; and echocardiography laboratories have contributed to the great increase in non-compaction cardiomyopathy diagnosis or over diagnosis. Certainly, although both 3D and contrast echocardiography can improve the assessment of this cardiomyopathy, we must not forget that cardiac magnetic resonance imaging (MRI) can also play an important role in its diagnosis. The spatial resolution of this technique, its ability for evaluating cardiac function and what is more, the tissue characterization by the late-gadolinium hyper-enhancement sequence makes it an excellent tool for the diagnosis of cardiomyopathies, especially in the case of non-compaction in which differential diagnosis from other entities such as hypertrophic cardiomyopathy, can sometimes be difficult. Late gadolinium enhancement is a surrogate of myocardial fibrosis, Nucifora et al.3 recently published a report in this journal demonstrating correlation of fibrosis with clinical severity and ventricular dysfunction in patients with non-compaction disease. Thus, fibrosis represents a marker of poor prognosis that could be used as a stratification tool in these patients, similar to that proposed for hypertrophic cardiomyopathy. Many questions remain about leftventricular non-compaction disease, but cardiac MRI can provide some of the answers: a more precise diagnosis based on a better endomyocardial definition and tissue characterization that can help to determine patient prognosis. Conflict of interest: none declared.