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Chapter 60: Left Ventricular Noncompaction

Which of the following imaging findings is consistent with a diagnosis of left ventricular noncompaction (LVNC)?

A. A ratio of noncompacted myocardium to compact myocardium > 2 in the parasternal short axis by echocardiography

B. A ratio of noncompacted myocardium to compact myocardium > 2.3 in the horizontal long axis by cardiac MRI

C. A ratio of noncompacted myocardium to compact myocardium > 1 in at least two segments of short axis images by multidetector CT

D. All of the above

E. A and B

The answer is E. (Hurst’s The Heart, 14th Edition, Chap. 60) A ratio of noncompacted myocardium to compact myocardium > 2 by echocardiography is consistent with a diagnosis of LVNC (option A).1 A ratio of noncompacted myocardium to compact myocardium > 2.3 in the horizontal long axis by cardiac MRI is consistent with a diagnosis of LVNC (option B).2 A ratio of noncompacted myocardium to compact myocardium >2.2 in at least 2 segments of short axis images by cardiac CT is consistent with a diagnosis of LVNC (option C).2

A 57-year-old man presents to your clinic to follow up a negative cardiac MRI (CMR) stress test for nonspecific chest pain. He was noted to have an increased ratio of noncompact to compact myocardium with normal left ventricular (LV) function. He is otherwise healthy. Which of the following is not true about compact and trabecular myocardium in the normal population?

A. The compacted layer but not the trabeculated layer is thicker in men than in women

B. The compacted layer thickens, whereas the trabeculated layer thins with systole

C. Trabeculated LV segments show increased systolic thinning of trabeculated layers and greater thickening of the compact segments with age

D. There are sex-specific differences in the trabeculated/compacted ratio at end systole or end diastole

E. In end systole, the trabeculated/compacted ratio is lower in older (50–79 years) subjects than in younger (20–49 years) subjects

The answer is D. (Hurst’s The Heart, 14th Edition, Chap. 60) CMR studies in normal adult volunteers demonstrated the following sex- and age-related differences: (1) the compacted but not the trabeculated layer is thicker in men than in women (option A); (2) the compacted layer thickens, whereas the trabeculated layer thins with systole (option B); (3) trabeculated LV segments show increased systolic thinning of trabeculated layers and greater thickening of the compact segments (P < .05) with age (option C); (4) total wall thickening is neither sex nor age dependent; (5) there were no sex-specific differences in the trabeculated/compacted ratio at end systole or end diastole (option D); and (6) in end systole, the trabeculated/compacted ratio was lower in older (50–79 years) subjects than in younger (20–49 years) subjects (P < .05) (option E).3 Overall, the application of current ...

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