There should not be any “probable” or “possible” left ventricular noncompaction

Abstract

Finsterer and coworkers are to be congratulated for their enthusiasm and intensive work on left ventricular noncompaction (LVNC) presented as numerous publications [1,2]. As readers of this journal may have already been familiar with this disease, LVNC is a rare cardiomyopathy due to intrauterine arrest of compaction of loose interwoven meshwork. Because of the poorly developed myocardium, patients with severe form of the disease often die in neonatal period. The majority of adult LVNC patients showed depressed LV function at initial presentation and their prognosis is poor because of heart failure, thromboembolism and lethal ventricular arrhythmia [3]. Treatment is similar to that of ordinary heart failure and surgical LV restoration with transmural stitches is recently reported to be a new treatment option by excluding the dyskinetic/akinetic LV segments and revitalizing LV function [4]. Since premortem diagnosis is essential for optimal management, the echocardiographic definition of LVNC is crucial rather than being diagnosed at autopsy. In the current world of cardiology, the LVNC criterion made by two groups, one by Finsterer's group and one by Oechslin's group, was exclusively quoted [1,3]. Recently several concerns about LVNC criteria made by Oechslin's group were raised by Finsterer's group [1] and I would like to take an opportunity to express my concerns about LVNC definition made by Finsterer's group from the perspective of third party without having any conflicts of interest with either group. Finsterer et al. insisted that it is difficult to differentiate between compacted and noncompacted layer in normal