Unresolved issues in left ventricular hypertrabeculation/noncompaction

Abstract

With interest we read the article of Alehan who described left ventricular hypertrabeculation/noncompaction (LVHT) in 9 children aged 10 days to 12 years [1]. The female to male ratio was 1:8. Seven of the nine patients had ECG abnormalities, five patients suffered from heart failure. During a follow-up period of 0.6 to 5 years, 2 patients died, in the further patients systolic function remained decreased in 4 and normal in 3. The presented findings, however, raise several concerns. The author mentions that LVHT is exclusively a congenital disorder. He does not seem to be aware that LVHT may also be acquired during lifetime in single patients. Three members of a family who subsequently developed LVHT did not show LVHT-characteristic changes by fetal echocardiographic studies. In these cases LVHT developed either postnatally, or was not visible on fetal echocardiography [2]. In a further case, LVHT was echocardiographically not present in the first days of life, but only at the age of 5 weeks [3]. In a single case, LVHT was documented to develop during life time [4,5]. Overall, the etiology of LVHT still remains unknown. The applied echocardiographic diagnostic criteria for LVHT are only one of three different definitions of LVHT [6]. Why did the author chose this particular definition, and would all 9 patients also fulfill the other 2 criteria for LVHT [7,8]? Were the measurement of the ratio of noncompacted to compacted myocardial layers performed at endsystole or enddiastole? According to the definition [6] this has to be done at endsystole. According to other and our experiences, recognition of the noncompacted