Left ventricular non-compaction (LVNC) cardiomyopathy is a rare congenital cardiomyopathy characterized by an excessive trabeculation and intertrabecular recesses within the left ventricle (LV). This abnormal myocardial architecture results in a spongy appearance of the LV myocardium, distinguishable from the normally compacted myocardium. While the precise etiology remains unclear, genetic factors are implicated, with various genes associated with its development. The clinical presentation is highly variable, ranging from asymptomatic individuals to those experiencing life-threatening arrhythmias, heart failure, or thromboembolic events. Echocardiography remains the cornerstone of diagnosis, but the lack of universally accepted criteria presents a significant challenge in its accurate and consistent identification. This article delves into the complexities of LVNC diagnosis, focusing specifically on echocardiographic criteria, while also addressing relevant guidelines and associated clinical implications.
Echocardiography: The Primary Diagnostic Tool
Echocardiography, including transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), is the primary imaging modality for the diagnosis of LVNC. It allows for visualization of the characteristic myocardial architecture, assessment of LV function, and detection of associated complications. However, the interpretation of echocardiographic findings can be subjective, contributing to the lack of consensus regarding diagnostic criteria. The challenge lies in differentiating between normal trabeculation, which is present to varying degrees in all individuals, and the excessive trabeculation that defines LVNC.
The Jenni Criteria and Subsequent Modifications
One of the most widely cited, albeit not universally accepted, criteria for diagnosing LVNC is the 2001 Jenni criteria. These criteria rely on the ratio of non-compacted to compacted myocardium (NC/C ratio) measured at end-systole. A ratio of ≥2.0 in a segment of the LV, along with the characteristic echocardiographic appearance of prominent trabeculae and deep recesses, was proposed as a diagnostic criterion. However, the limitations of this approach are significant. The NC/C ratio can be influenced by various factors, including image quality, the angle of echocardiographic acquisition, and the subjective interpretation of what constitutes "compacted" versus "non-compacted" myocardium. Furthermore, the cut-off value of 2.0 is arbitrary and not consistently validated across different populations and echocardiographic machines.
Subsequent studies have attempted to refine the Jenni criteria and address their limitations. Some researchers have proposed using a combination of the NC/C ratio with other echocardiographic features, such as the presence of deep intertrabecular recesses and the extent of involvement of the LV wall. Others have suggested different cut-off values for the NC/C ratio, or even advocate for a qualitative assessment of the myocardial architecture, relying less on quantitative measurements. The lack of standardization in echocardiographic techniques and image analysis further complicates the diagnostic process.
LV Non-Compaction Guidelines: A Landscape of Variability
The absence of universally accepted guidelines for the diagnosis of LVNC reflects the inherent difficulties in defining and characterizing this condition. While various professional societies and organizations have published guidelines or recommendations, there is considerable heterogeneity in their approach. These guidelines often incorporate the Jenni criteria, but also emphasize the importance of clinical correlation and the consideration of other echocardiographic findings. The guidelines typically highlight the need for careful assessment of LV function, arrhythmias, and thromboembolic risk, as these are crucial aspects of the clinical management of LVNC.
current url：https://fufcth.k177t.com/news/lv-non-compaction-echo-criteria-87248
miss dior fresh rose body oil review chanel allure black bottle