title: Hypertrabeculation vs left ventricular noncompaction on echocardiogram: a reason to restrict athletic participation?
abstract: OBJECTIVE
  Left ventricular noncompaction (LVNC) is a rare cause of progressive cardiomyopathy thought to result from incomplete myocardial development. It has been associated with an increased risk of sudden death, especially in those with a depressed left ventricular ejection fraction. Thus, the current recommendation for patients with this diagnosis is restriction from participation in competitive sports.
  
  
  METHODS
  An asymptomatic 18-year-old African American collegiate football player had a murmur on his preparticipation physical examination. Subsequent cardiology workup revealed hypertrabeculation vs LVNC. Second and third opinions were sought from national experts in the field: one gave the diagnosis of LVNC and recommended restriction; the other gave the diagnosis of hypertrabeculation. After a family meeting including the player, mother, team physician, and consulting cardiologist, the player was permitted to participate in football.
  
  
  CONCLUSIONS
  Distinguishing between pathologic LVNC and physiologic hypertrabeculation is a diagnostic challenge and is becoming increasingly commonplace with enhanced echocardiography and magnetic resonance imaging modalities. Given the limited data on such patients, careful workup and discussion between patient and providers is required.
authors.affiliation: Department of Medicine/Pediatrics, University of North Carolina at Chapel Hill.
authors.forename: David C
authors.initials: DC
authors.lastname: Peritz
authors.affiliation: Department of Family Medicine, University of North Carolina at Chapel Hill3Department of Sports Medicine, University of North Carolina at Chapel Hill.
authors.forename: Aaron
authors.initials: A
authors.lastname: Vaughn
authors.affiliation: Sports Medicine, Campus Health, University of North Carolina at Chapel Hill.
authors.forename: Mario
authors.initials: M
authors.lastname: Ciocca
authors.affiliation: Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill.
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D005538:Football; D006337:Heart Murmurs / Q000209:etiology; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D056830:Isolated Noncompaction of the Ventricular Myocardium / Q000175:diagnosis / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008297:Male; D016277:Ventricular Function, Left