Myocardial MRI enhancement patterns in patients with left ventricular noncompaction hypertrabeculation cardiac morphology and thromboembolic events

Abstract

Abstract Left ventricular noncompaction cardiomyopathy (LVNC) is an idiopathic non-ischemic cardiomyopathy with subendocardial hypertrabeculation morphology. LVNC is associated with thromboembolic events which are thought to originate from trabeculae and associated recesses. The standard therapy for thromboembolic disease is anticoagulation, however, the timing of treatment initiation is controversial. The aim of the study is to examine the association between thromboembolic events and patterns of cardiac MRI delayed enhancement. Patients with MRI criteria for non-compaction cardiomyopathy were included. The patients were screened for ischemic coronary disease. Images from cardiac MRI were reviewed for delayed enhancing. Cardiac function was also recorded. Medical records were searched for evidence of thrombotic or thromboembolic events. Statistical analysis was performed to investigate the association between delayed myocardial enhancement patterns and thromboembolic events. Results Fifty-two patients were included in the study. Thirty one patients had delayed enhancement of the myocardium. Of these 12 had an ischemic pattern of enhancement. Eleven patients had thromboembolic events and of these 6 had ischemic pattern of enhancement. Of the various parameters examined ischemic pattern of enhancement was associated with these events. Conclusion: An association between ischemic pattern of enhancement and distal thromboembolic events was found in patients with hypertrabeculated myocardium that meet MRI ratio criteria for non compaction cardiomyopathy. The etiology of this association is unclear, however, may be attributed to auto-infarction, whereby thrombi from the myocardium embolize to coronary arteries. This association can potentially guide therapeutic approach of anticoagulation in patients with LVNC.