title: Cardiovascular magnetic resonance determinants of left ventricular noncompaction.
abstract: Insufficient precision remains in accurately identifying left ventricular noncompaction (LVNC) from the healthy normal morphologic spectrum. We aim to provide a better distinction between normal left ventricular trabeculations and LVNC. We used a previously well-defined cohort of 120 healthy volunteers for normal reference values of the trabecular/compacted ratio derived from a consistent selection of short-axis cardiovascular magnetic resonance images. We performed forward selection of logistic regression models, selecting the best model that was subsequently assessed for discrimination and calibration, validated, and converted into a clinical diagnostic chart to benchmark the boundaries of detection from a cohort of 30 patients considered to have LVNC. We showed that 3 combinations of a maximal end-diastolic trabecular/compacted ratio (≥1 [apex], >1.8 [midcavity]), (>2 [apex], ≥0.6 [midcavity]), or (>0.5 [base], >1.8 [midcavity]) separate the cohorts with the highest accuracy (C statistic [95% confidence interval] of 0.9749 (0.9748 to 0.9751) for the diagnostic chart). Quantitative cardiovascular magnetic resonance also shows that patients considered to have LVNC have a significantly reduced ejection fraction compared with normal volunteers. At midcavity and apical level, it is difficult to identify papillary muscles that are replaced by a dense trabecular meshwork. In conclusion, we developed a new, refined, diagnostic tool for identifying LVNC, based on an a priori assessment of the trabecular architecture in healthy volunteers.
authors.affiliation: Cardiovascular Medicine Research Unit, University of Aberdeen, Aberdeen, United Kingdom. Electronic address: dana.dawson@abdn.ac.uk.
authors.forename: Dana K
authors.initials: DK
authors.lastname: Dawson
authors.affiliation: Cardiovascular Medicine Research Unit, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: David J
authors.initials: DJ
authors.lastname: McLernon
authors.affiliation: Leicester Royal Infirmary, Leicester, United Kingdom.
authors.forename: Vimal J
authors.initials: VJ
authors.lastname: Raj
authors.affiliation: ERESA-Cardiac Imaging Unit, Valencia, Spain.
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Maceira
authors.affiliation: NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College, London, United Kingdom.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Prasad
authors.affiliation: Cardiovascular Medicine Research Unit, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Frenneaux
authors.affiliation: NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College, London, United Kingdom.
authors.forename: Dudley J
authors.initials: DJ
authors.lastname: Pennell
authors.affiliation: NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College, London, United Kingdom.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Kilner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D064368:Healthy Volunteers; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D056830:Isolated Noncompaction of the Ventricular Myocardium / Q000175:diagnosis* / Q000503:physiopathology; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D055815:Young Adult