Abstract
The ventricular walls of the human heart comprise an outer compact layer and an inner trabecular layer. In the context of an increased pre‐test probability, diagnosis left ventricular noncompaction cardiomyopathy is given when the left ventricle is excessively trabeculated in volume (trabecular vol >25% of total LV wall volume) or thickness (trabecular/compact (T/C) >2.3). Here, we investigated whether higher spatial resolution affects the detection of trabeculation and thus the assessment of normal and excessively trabeculated wall morphology. First, we screened left ventricles in 1112 post‐natal autopsy hearts. We identified five excessively trabeculated hearts and this low prevalence of excessive trabeculation is in agreement with pathology reports but contrasts the prevalence of approximately 10% of the population found by in vivo non‐invasive imaging. Using macroscopy, histology and low‐ and high‐resolution MRI, the five excessively trabeculated hearts were compared with six normal hearts and seven abnormally trabeculated and excessive trabeculation‐negative hearts. Some abnormally trabeculated hearts could be considered excessively trabeculated macroscopically because of a trabecular outflow or an excessive number of trabeculations, but they were excessive trabeculation‐negative when assessed with MRI‐based measurements (T/C <2.3 and vol <25%). The number of detected trabeculations and T/C ratio were positively correlated with higher spatial resolution. Using measurements on high resolution MRI and with histological validation, we could not replicate the correlation between trabeculations of the left and right ventricle that has been previously reported. In conclusion, higher spatial resolution may affect the sensitivity of diagnostic measurements and in addition could allow for novel measurements such as counting of trabeculations.
Highlights
Trabeculations line the luminal side of the walls of the human cardiac ventricles and compact wall comprises the epicardial side (Greenbaum et al, 1981; Streeter Jr, 1979)
Four of the five excessively trabeculated hearts came from the T archive (N = 629), one heart came from the S archive (N = 483), but the prevalence of excessive trabeculation was not significantly different between the two archives (p = 0.295)
Since much of the variation in LV trabecular volume came from the excessively trabeculated hearts, we tested whether the LV trabecular proportion (%) was correlated to total ventricular volume and right ventricle (RV)/LV ratio, and we found non-significant correlations in both instances (Figure 12b,c)
Summary
Trabeculations line the luminal side of the walls of the human cardiac ventricles and compact wall comprises the epicardial side (Greenbaum et al, 1981; Streeter Jr, 1979). Noncompaction is the hypothesized aetiology defined as a failure of compaction (Chin et al, 1990), where compaction itself is a process originally described in chicken whereby embryonic trabeculation coalesce to become compact wall (Rychterova, 1971). We prefer the term ‘excessive trabeculation’ as introduced by (Anderson et al, 2017). It describes the setting of a few large trabeculations, or hypertrabeculation (Finsterer et al, 2017), and, or, the setting of a great number trabeculations, or so-called ‘noncompaction’, while being neutral to the aetiology, or aetiologies, behind excessive trabeculation (Anderson et al, 2017)
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