Diagnostic accuracy of noncompacted-to-compacted wall ratio criteria on CMRI for the diagnosis of left ventricular noncompaction

Year 2019, Volume: 32 Issue: 3, 124 - 129, 31.10.2019

Deniz Alıs Ahmet Anil Sahın Arda Guler Ozan Asmakutlu

https://doi.org/10.5472/marumj.637581

Abstract

Objectives: To investigate the diagnostic accuracy of the current criterion, noncompacted-to-compacted (NC/C) wall ratio > 2.3 on

cardiac magnetic resonance imaging (CMRI) for the diagnosis of left ventricular noncompaction (LVNC).

Materials and Methods: We retrospectively enrolled 37 patients as an LVNC group and a total of 97 participants with ischemic,

hypertrophic, and dilated cardiomyopathy and healthy controls as a control group. The NC/C ratio was measured perpendicularly

on short-axis cine images for segments 1-16 and four-chamber cine images for the apex during the end-diastole. The sensitivity,

specificity, and diagnostic accuracy of NC/C ratio > 2.3 for the diagnosis of LVNC were calculated.

Results: LVNC patients comprised 24 males (64.8%) and 13 females (35.2%) with the mean age of 29.24 ± 11.79 years. The NC/C ratio

> 2.3 detected in all but one of the LVNC patients (97.3%). On the other hand, the specificity of NC/C ratio > 2.3 was 79.4% for the

diagnosis of the LVNC patients. Using NC/C ratio > 2.66 and > 2.8 yielded 91.9% sensitivity and 97% specificity, and 81% sensitivity

and 100% specificity, respectively.

Conclusion: NC/C ratio > 2.3 might lead to overdiagnosis of LVNC. We suggest using higher NC/C cut-off value in individuals

without high clinical suspicion of LVNC.

Keywords

Accuracy, Cardiomyopathy, CMR, Cut-off, Noncompaction

References

• [1] Ritter M, Oechslin E, Sutsch G, Attenhofer C, Schneider J, Jenni R. Isolated noncompaction of the myocardium in adults. Mayo Clin Proc 1997; 72:26-31. doi: 10.1016/j.jacc.2015.06.017
• [2] Oechslin EN, Attenhofer Jost CH, Rojas JR, Kaufmann PA, Jenni R. Long-term follow-up of 34 adults with isolated left ventricular noncompaction: a distinct cardiomyopathy with poor prognosis. J Am Coll Cardiol 2000; 36:493-500. doi: 10.1016/S0735-1097(00)00755-5
• [3] Oechslin E, Jenni R. Left ventricular non-compaction revisited: a distinct phenotype with genetic heterogeneity? Eur Heart J 2011; 32:1446-56. doi:10.1093/eurheartj/ehq508
• [4] Elliott P, Andersson B, Arbustini E, et al. Classification of the cardiomyopathies: a position statement from the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2008; 29:270-6. doi: 10.1093/eurheartj/ehm342
• [5] Maron BJ, Towbin JA, Thiene G, et al. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation 2006; 113:1807-16. doi: 10.1161/CIRCULATIONAHA.106.174287
• [6] Ichida F, Tsubata S, Bowles KR, et al. Novel gene mutations in patients with LV noncompaction or Barth syndrome. Circulation 2001; 103:1256–63. https://doi.org/10.1161/01.cir.103.9.1256
• [7] Klaassen S, Probst S, Oechslin E, et al. Mutations in sarco- mere protein genes in LV noncompaction. Circulation 2008; 117:2893-2901. doi: 10.1161/CIRCGENETICS.109.903898
• [8] Sasse-Klaassen S, Gerull B, Oechslin E, Jenni R, Thierfelder L. Isolated noncompaction of the LV myocardium in the adult is an autosomal dominant disorder in the majority of patients. Am J Med Genet A 2003; 119:162-7. doi: 10.1002/ajmg.a.20075
• [9] Jenni R, Oechslin E, Schneider J, Attenhofer Jost CH, Kaufmann PA. Echocardiographic and pathoanatomical characteristics of isolated LV non-compaction: a step towards classification as a distinct cardiomyopathy. Heart 2001; 86:666-71. doi: 10.1136/heart.86.6.666
• [10] Oechslin EN, Jost CHA, Rojas JR, Kaufmann PA, Jenni R, Long-term follow-up of 34 adults with isolated left ventricular noncompaction: a distinct cardiomyopathy with poor prognosis. J Am Coll Cardiol 2000; 36:493–500. doi:10.1016/s0735-1097(00)00755-5
• [11] Martin M, Barriales V, Corros C, Santamaria E. Usefulness of cardiac magnetic resonance imaging in LV non-compaction cardiomyopathy. Eur J Heart Fail 2011; 13:177-85. doi: 10.1093/eurjhf/hfr028
• [12] Petersen SE, Selvanayagam JB, Wiesmann F, et al. LV non-compaction: insights from cardiovascular magnetic resonance imaging. J Am Coll Cardiol 2005; 46:101-5. doi: 10.1016/j.jacc.2005.03.045
• [13] Kawel N, Nacif M, Arai AE, et al. Trabeculated (noncompacted) and compact myocardium in adults: the multi-ethnic study of atherosclerosis. Circ Cardiovasc Imaging 2012; 5:357–66. https://doi.org/10.1161/CIRCIMAGING.111.971713
• [14] Tizon-Marcos H, de la Paz RM, Pibarot P, et al. Characteristics of trabeculated myocardium burden in young and apparently healthy adults. Am J Cardiol. 2014; 114:1094-9. doi: 10.1016/j.amjcard.2014.07.025
• [15] Grothoff M, Pachowsky M, Hoffmann J, et al. Value of cardiovascular MR in diagnosing left ventricular non-compaction cardiomyopathy and in discriminating between other cardiomyopathies. Eur Radiol 2012; 22:2699-2709. doi:10.1007/s00330-012-2554-7
• [16] Zuccarino F, Vollmer I, Sanchez G, Navallas M, Pugliese F, Gayete A. Left ventricular noncompaction: imaging findings and diagnostic criteria. AJR Am J Roentgenol 2015; 204:519-30. doi: 10.2214/AJR.13.12326
• [17] Cerqueira MD, Weissman NJ, Dilsizian V, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002; 105:539-42. doi: 10.1161/hc0402.102975
• [18] Boban M, Pesa V, Beck N, et al. Supplementary diagnostic landmarks of left ventricular non-compaction on magnetic resonance imaging. Yonsei Med J 2018; 59:63-71. doi: 10.3349/ymj.2018.59.1.63
• [19] Fazio G, Novo G, D'angelo L, Visconti C, et al. Magnetic resonance in isolated noncompaction of the ventricular myocardium. Int J Cardiol Heart Vasc 2010; 140:367-9. doi: 10.1016/j.ijcard.2008.11.080
• [20] Chrissoheris MP, Ali R, Vivas Y, Marieb M, Protopapas Z. Isolated noncompaction of the ventricular myocardium: contemporary diagnosis and Management. Clin Cardiol 2007; 30:156–60. doi: 10.1002/clc.20004
• [21] Murphy RT, Thaman R, Blanes JG, et al. Natural history and familial characteristics of isolated left ventricular non-compaction. Eur Heart J 2005; 26:187-92. doi: 10.1093/eurheartj/ehi025
• [22] Choi Y, Kim SM, Lee SC, Chang, SA, Jang,SY, Choe YH. Quantification of left ventricular trabeculae using cardiovascular magnetic resonance for the diagnosis of left ventricular non-compaction: evaluation of trabecular volume and refined semi-quantitative criteria. J Cardiovasc Magn Reson 2016; 18:24. doi: 10.1186/s12968-016-0245-2
• [23] Captur G, Muthurangu V, Cook C, et al. Quantification of left ventricular trabeculae using fractal analysis. J Cardiovasc Magn Reson 2013; 15:36. doi: 10.1186/1532-429X-15-36
• [24] Gati S, Rajani R, Carr-White GS, Chambers JB. Adult left ventricular noncompaction: reappraisal of current diagnostic imaging modalities. JACC: Cardiovascular Imaging 2014; 7:1266-75. doi: 10.1016/j.jcmg.2014.09.005