Needed—Electrocardiographic Findings in Left Ventricular Noncompaction

Abstract

This comment is in response to the contribution by Greutmann et al 1 Greutmann M. Mah M.L. Silversides C.K. Klaassen S. Attenhofer Jost C.H. Jenni R. Oechslin E.N. Predictors of adverse outcome in adolescents and adults with isolated left ventricular noncompaction. Am J Cardiol. 2012; 109: 276-281 Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar in the January 15, 2012, issue of The American Journal of Cardiology on adverse outcomes in 155 patients with isolated left ventricular (LV) noncompaction, 77% of whom were symptomatic when their condition was identified. At a median follow-up time of 2.7 years, none of the asymptomatic and 31% of the symptomatic patients had died or undergone transplantation. The major determinants of these 2 outcomes were presentation with a cardiovascular complication, New York Heart Association class ≥III. As in a study by Stöllberger et al 2 Stöllberger C. Grassberger M. Finsterer J. Left ventricular noncompaction/hypertrabeculation: distinctive entity or abnormality, frequently associated with neuromuscular disorders?. Am J Cardiol. 2011; 108: 1200-1201 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar recently published in the Journal, the electrocardiographic data are scanty. Indeed, the investigators listed in Tables 1, 2, and 4 only atrial fibrillation and bundle branch block (type not specified) and in Table 3 sustained ventricular tachycardia. It would have been appropriate at least to report on LV hypertrophy, considering that their symptomatic patients had higher rates of LV dilatation and decreased LV ejection fractions. The investigators refer to “the thickened 2-layered myocardium consisting of a thin compacted outer (epicardial) and a much thicker noncompacted inner (endocardial) layer with a deep intratrabecular recesses”; is it possible that the intraventricular conduction is affected in patients with LV noncompaction because of alterations in the extent, distribution, or functional characteristics of the Purkinje network or the absolute thickness of the compacted and noncompacted myocardial layers? Stöllberger et al 2 Stöllberger C. Grassberger M. Finsterer J. Left ventricular noncompaction/hypertrabeculation: distinctive entity or abnormality, frequently associated with neuromuscular disorders?. Am J Cardiol. 2011; 108: 1200-1201 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar reported on the presence of left bundle branch block and Q waves in their patients. Could Greutmann et al 1 Greutmann M. Mah M.L. Silversides C.K. Klaassen S. Attenhofer Jost C.H. Jenni R. Oechslin E.N. Predictors of adverse outcome in adolescents and adults with isolated left ventricular noncompaction. Am J Cardiol. 2012; 109: 276-281 Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar oblige by supplying information on the frequency of LV hypertrophy, Q waves, left bundle branch block, right bundle branch block, and left anterior and posterior hemiblocks, as well as QRS duration, QT interval, corrected QT interval, and PR interval, in their patients? Predictors of Adverse Outcome in Adolescents and Adults With Isolated Left Ventricular NoncompactionAmerican Journal of CardiologyVol. 109Issue 2PreviewIsolated left ventricular noncompaction is a rare form of primary cardiomyopathy. Although increasingly diagnosed, data on the outcomes are limited. To define the predictors of adverse outcomes, we performed a retrospective analysis of a prospectively defined cohort of consecutive patients (age >14 years) diagnosed with left ventricular noncompaction at a single center. The baseline characteristics included presentation with a cardiovascular complication (i.e., decompensated heart failure, systemic embolic event, or sustained ventricular arrhythmia). Full-Text PDF Authors' ReplyAmerican Journal of CardiologyVol. 109Issue 11PreviewWe wish to thank Dr. Madias for his interest in our report.1 With regard to electrocardiographic data, the types of bundle branch block were specified in the footnote of Table 1 (of 32 patients with bundle branch block, 28 had left bundle branch block and 4 had right bundle branch block). Table 3 lists major adverse cardiovascular events, which includes sustained ventricular arrhythmias. Full-Text PDF