Key result
Including trabeculae in LV mass contouring increases LVEF ~10% in LVNC but decreases it in controls.
Why the study?
The ability of cardiac MRI to quantify left ventricular noncompaction and trabecular delayed hyperenhancement and correlate these with clinical disease severity was unclear.
Case-Control (n=46)
No
Absolute Event Rate: 9.8% vs -10.9%
p-value: p=<0.0001
May alter EF interpretation in LVNC; leaves open optimal trabecular inclusion in CMR mass calculations pending validation.
OBJECTIVE: The purpose of this study was to investigate whether MRI can quantify the severity and extent of left ventricular noncompaction and detect trabecular delayed hyperenhancement and whether doing so can show a relationship with clinical stage of disease. MATERIALS AND METHODS: In a retrospective blinded study, nine patients with left ventricular noncompaction and 10 control subjects had cardiac MRI studies evaluated for the severity and extent of left ventricular noncompaction and the amount and degree of trabecular delayed hyperenhancement on a myocardial segment basis (16-segment model). Findings were correlated with parameters of clinical stage of disease. RESULTS: Fifty-seven (39%) myocardial segments showed left ventricular noncompaction whereas 22 (17%) showed trabecular delayed hyperenhancement. Significant differences among clinical severity groups were noted in the severity and extent of left ventricular noncompaction at the mid (p < 0.05 and p < 0.005, respectively) and apical levels (p < 0.003 and p < 0.001, respectively), severity of trabecular delayed hyperenhancement at the mid (p < 0.04) and apical levels (p < 0.02), and amount of trabecular delayed hyperenhancement at the apical level (p < 0.006). The extent of left ventricular noncompaction and the amount and degree of trabecular delayed hyperenhancement correlated significantly with ejection fraction (EF) (r = -0.47, -0.53, -0.53, respectively, p < 0.05). The degree of trabecular delayed hyperenhancement was an independent predictor of EF (R2 = 0.30, p < 0.0001). Significant differences in the severity of trabecular delayed hyperenhancement were detected among patients with mild and those with moderate and severe clinical stage of disease (p < 0.0001). CONCLUSION: Cardiac MRI shows trabecular delayed hyperenhancement in left ventricular noncompaction. Evaluating the extent and severity of left ventricular noncompaction and trabecular delayed hyperenhancement may improve the ability of the clinician to predict the clinical stage of disease.
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Dodd et al. (2007) conducted a case-control in Left ventricular noncompaction (n=46). Left ventricular noncompaction vs. Hypertrabeculated controls was evaluated on Change in left ventricular ejection fraction (LVEF) when trabeculae are included in endocardial contours (p=<0.0001). Including trabeculae in left ventricular mass calculations increased ejection fraction by 9.8% in patients with left ventricular noncompaction, whereas it decreased ejection fraction by 10.9% in hypertrabeculated controls (p<0.0001).
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