Abstract 9912: A Case of Left Ventricle Non-Compaction in an Asymptomatic Athlete

Abstract

Introduction: Left ventricle non-compaction (LVNC) is defined as a primary genetic cardiomyopathy by the American Heart Association and as an unclassified cardiomyopathy by the European Society of Cardiology. Phenotypically, it is characterized by prominent trabeculations and intertrabecular recesses in the ventricular cavity. The clinical manifestations of LVNC range from an asymptomatic state to progressive heart failure and life-threatening arrhythmias. The following case highlights an athletic patient with LVNC. Case Presentation: A 22-year-old male presented to the cardiology clinic for evaluation prior to enrolling in the police academy. At age 15, an echo revealed prominent trabeculations. The patient has been a competitive soccer player since high school. Upon presentation, he was asymptomatic with non-specific T wave changes noted on ECG, stress echocardiography revealed preserved functional capacity, prominent trabeculations, and EF 55%. No arrhythmias were noted. CMR revealed a hyper-trabeculated LV predominantly at the mid-ventricular and apical segments, moderate left and right ventricular enlargement with EF 55%. No LGE enhancement was noted. Discussion: LVNC is estimated to affect 8-12 patients per 1 million annually, but the actual number is likely higher as many individuals are asymptomatic. Although the cause of LVNC is unclear, it has been associated with mutations in sarcomere encoding genes including MYH7 and MYBPC3. It remains controversial whether LVNC is a distinct disorder since it has been reported in other cardiomyopathies and since it has been reported in pregnancy and trained athletes. The current diagnostic criteria for LVNC include a ratio of non-compacted to compacted myocardium >2.1:1 as demonstrated by echo or a ratio of >2.3:1 by CMR. However, it has been proposed that trabeculation formation represents a physiological adaptation to increased loading conditions seen in pregnancy and vigorously trained athletes. Therefore, it remains unclear whether the current diagnostic criteria apply to an athletic population. Furthermore, the prognostic implications of prominent trabeculations meeting accepted diagnostic criteria for LVNC remain uncertain.