Copyright © Italian Federation of Cardiology. Unauthorized reproduction of this article is prohibited. Biventricular non-compaction demonstrated on multi-slice computed tomography with echocardiographic correlation Saverio Grillone a , Gaetano Nucifora b , Gianluca Piccoli a , Pasquale Gianfagna b , Fjoralba Hysko c , Daisy Pavoni b , Gianaugusto Slavich b , Alessandro Proclemer b and Daniele Gasparini a Left ventricular non-compaction (LVNC) is a myocardial disorder characterized by prominent trabeculations and deep intertrabecular recesses within the left ventricular wall. Multi-slice computed tomography (CT) might represent a valid non-invasive imaging technique for the diagnostic work-up of these patients, being able to visualize the compacted and non-compacted layers and to simultaneously rule out the presence of associated coronary artery disease and congenital heart disease. In the present report, the CT features of LVNC are described. J Cardiovasc Med 2013, 14:677–680 Keywords: echocardiography, left ventricular non-compaction, magnetic resonance imaging, multi-slice computed tomography a Division of Diagnostic Angiography and Interventional Radiology, Department of Diagnostic Imaging, b Division of Cardiology, Cardiothoracic Department, University Hospital ‘Santa Maria della Misericordia’, Udine, Italy and c Division of Radiology, Latisana General Hospital, Latisana, Italy Correspondence to Gaetano Nucifora, MD, FESC, Division of Cardiology, Cardiothoracic Department, University Hospital ‘Santa Maria della Misericordia’, Udine, Italy. P.le Santa Maria della Misericordia, 33100 Udine, Italy Tel: +39432552441; fax: +39432482353; e-mail: gnucifora@cardionet.it Received 17 February 2012 Revised 18 April 2012 Accepted 5 June 2012 A 63-year-old man without known coronary risk factors was referred to our hospital because of progressively worsening heart failure symptoms. His medical history was remarkable for pacemaker implantation 5 years before because of complete atrioventricular block. The patient was initially evaluated with transthoracic echo- cardiography, which showed biventricular dilatation and severe impairment of systolic function of both the left (LV) and right ventricle (RV). Sponge-like trabeculae within the LV anterior, inferior and lateral wall, with a non-compacted to compacted myocardium end-systolic ratio more than 2, and marked trabeculation of the RV were observed (Fig. 1). Colour Doppler showed flow between the ventricular cavities and the intertrabecular spaces (Fig. 2). These features led to the suspicion of biventricular non-compaction. In order to provide a better characterization of the cardiomyopathy, and to rule out the presence of associated coronary artery disease (CAD) and congenital heart disease (CHD), ECG-gated 64-slice computed tomography (CT) was performed. The coronary arteries were normal, although a persistent left inferior vena cava with hemiazygos continuation draining into the right atrium through an enlarged coronary sinus was observed (Figs 3 and 4). The presence of a non- compacted endocardial layer, consisting of a trabecular meshwork and deep intertrabecular spaces, and a com- pacted epicardial layer, for both the LV and RV was documented (Fig. 1), confirming the diagnosis of biven- tricular non-compaction. A non-compacted to compacted myocardium ratio more than 2.3 was measured for the anterior, inferior and lateral LV wall. Left ventricular non-compaction (LVNC) is a myocardial disorder included among the primary genetic cardiomyo- pathies and the unclassified cardiomyopathies in the World Health Organization and European Society of Cardiology classifications, respectively. 1,2 It is character- ized by prominent trabeculations and deep intertrabecu- lar recesses within the LV wall; these features are thought to be related to an arrest in the normal embryogenesis of the endocardium and myocardium. 1,2 LVNC has a broad spectrum of clinical and pathophy- siological findings; the age at onset of symptoms in LVNC is also highly variable. 3,4 LV systolic function at the time of diagnosis may range from completely normal to severely reduced and clinical manifestations may encompass asymptomatic LV dysfunction, severe con- gestive heart failure, arrhythmias and embolic events. 3,4 The onset of cardiac symptoms is frequently delayed until adulthood and patients older than 60 years at diagnosis have been described. 3 Late onset of symptoms in LVNC may be related to progressive ventricular dys- function caused by impaired microvascular function superimposed on the primary cardiomyopathic process; 3 microcirculatory dysfunction has indeed been postulated to occur LVNC, accounting for subendocardial ischaemia and scarring. 4 Echocardiography, eventually with the use of echo con- trast agent, is the key non-invasive tool for the diagnosis of LVNC. 5 Several echocardiographic criteria for the diagnosis of LVNC have been proposed previously, mainly relying on location of the pathology (mid-lateral, Images in cardiovascular medicine 1558-2027 ß 2013 Italian Federation of Cardiology DOI:10.2459/JCM.0b013e328356a4a6