Transcript Case of the week – 06-02 - Society for Cardiovascular

Case of the week 08-07 CMR and echo in LVNC
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 noncompacted 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.
A
C
B
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