Case of the week 08-07 CMR and echo in LVNC

1. Case of the week 08-07 CMR and echo in LVNC A B History:18 Y/O male presented with dyspnea and palpitations. His father had died suddenly at age 32. Echocardiogram: Global Hypokinesis and hyper-trabeculation suggestive of non-compaction. (A) CMR Referral: To establish a diagnosis of left ventricular non-compaction (LVNC). CMR Interpretation: Dilated hypokinetic left ventricle. Ratio of non-compacted to compacted myocardium at end diastole in the midventricle was 2:1. The hyper-trabeculation was present in anterolateral, lateral, inferolateral, and apical walls sparing the septum. (B,C, & D) CMR Perspective: The trabecular architecture was better appreciated with CMR leading to a proposed diagnosis of LVNC cardiomyopathy. Although often seen in LVNC, LGE was not observed in this patient. Clinical Course: The treatment initiated was for DCM and heart failure– although with a lower threshold for warfarin. During his initial evaluation multiple episodes of non-sustained ventricular tachycardia were documented. An AICD was inserted. C D References:(1)Virmani R et al; Hum Pathol. 2005;36(4):403-11; (2) Jenni R; et al Heart 2007;93;11-15; (3) Petersen SE et al. J Am Coll Cardiol. 2005 Jul 5;46(1):101-5. E Bergen, S Javaheri, G York: Brooke Army Medical Center, Fort Sam Houston, Texas