Left-ventricular non-compaction cardiomyopathy (LVNC) is an uncommon myocardial condition characterized by prominent trabeculae and deep blood-filled recesses. The rise of cardiac magnetic resonance (CMR) has multiplied its detection. Debate persists over whether it is a distinct entity or a phenotype shared with other cardiomyopathies. Because LVNC expression depends on the interplay between genotype, sex, ethnicity, and hemodynamic load, it represents a paradigmatic model for precision cardiology.Methodology: A narrative review was conducted of literature published between January 2000 and April 2025 in PubMed, Scopus, and Google Scholar. Clinical studies with at least 10 patients, meta-analyses, reviews, and consensus statements addressing LVNC pathophysiology, genetics, diagnosis, or treatment were included. The review is based on 30 articles selected for relevance and currency.Results: Sarcomeric mutations (MYH7, ACTN2) explain up to one-third of cases and link LVNC with dilated (DCM) and hypertrophic (HCM) cardiomyopathies. The Chin, Jenni, and Stöllberger criteria (echocardiography) and the Petersen and Jacquier criteria (CMR) identify the disease but blur the line between physiological and pathological hyper-trabeculation. The presence of fibrosis (late gadolinium enhancement, LGE) and systolic dysfunction worsen prognosis 8, 19, 20. Current management is extrapolated from heart failure: neuro-hormonal blockers, SGLT2 inhibitors, and an implantable cardioverter-defibrillator (ICD) if LVEF ≤ 35 % or malignant arrhythmias are present.Conclusions: Optimal management of LVNC requires integrating clinical, imaging, and genetic information. The lack of universal diagnostic criteria underscores the need for prospective studies and international consensus to standardize diagnosis and treatment of this entity. Future algorithms that integrate multi‑omics, advanced imaging, and AI‑based risk prediction could individualize surveillance, pharmacotherapy, and device therapy, fulfilling the promise of personalized medicine in LVNC.
Martínez-Tittonel et al. (Mon,) studied this question.