Clinical Investigation
Ventricular Mechanics
Diagnostic Value of Rigid Body Rotation in Noncompaction Cardiomyopathy

https://doi.org/10.1016/j.echo.2011.01.002Get rights and content

Background

The diagnosis of noncompaction cardiomyopathy (NCCM) remains subject to controversy. Because NCCM is probably caused by an intrauterine arrest of the myocardial fiber compaction during embryogenesis, it may be anticipated that the myocardial fiber helices, normally causing left ventricular (LV) twist, will also not develop properly. The resultant LV rigid body rotation (RBR) may strengthen the diagnosis of NCCM. The purpose of the current study was to explore the diagnostic value of RBR in a large group of patients with prominent trabeculations.

Methods

The study comprised 15 patients with dilated cardiomyopathy, 52 healthy subjects, and 52 patients with prominent trabeculations, of whom a clinical expert in NCCM defined 34 as having NCCM. LV rotation patterns were determined by speckle-tracking echocardiography and defined as follows: pattern 1A, completely normal rotation (initial counterclockwise basal and clockwise apical rotation, followed by end-systolic clockwise basal and counterclockwise apical rotation); pattern 1B, partly normal rotation (normal end-systolic rotation but absence of initial rotation in the other direction); and pattern 2, RBR (rotation at the basal and apical level predominantly in the same direction).

Results

The majority of normal subjects had LV rotation pattern 1A (98%), whereas the 18 subjects with hypertrabeculation not fulfilling diagnostic criteria for NCCM predominantly had pattern 1B (71%), and the 34 patients with NCCM predominantly had pattern 2 (88%). None of the patients with dilated cardiomyopathy showed RBR. Sensitivity and specificity of RBR for differentiating NCCM from “hypertrabeculation” were 88% and 78%, respectively.

Conclusions

RBR is an objective, quantitative, and reproducible functional criterion with good predictive value for the diagnosis of NCCM as determined by expert opinion.

Section snippets

Study Participants

The study population consisted of 30 patients diagnosed before 2008 with NCCM by expert opinion (of whom 10 were included in a previous study on LV twist in NCCM)9 and 22 consecutive patients with prominent trabeculations (visual estimated end-systolic ratio of noncompacted to compacted layer >1.5) who underwent echocardiography in 2008, identified by one physician highly experienced with echocardiography (M.L.G.). All patients were in sinus rhythm and had good echocardiographic image quality

Characteristics of the Study Population

Revision of the 30 patients with previously established diagnoses of NCCM led to confirmation of the diagnosis in 29 by the criteria of Jenni et al.10 and in all 30 by expert opinion. Of the 22 patients with various degrees of hypertrabeculation, seven were classified as having NCCM by the criteria of Jenni et al. and four by expert opinion. The remaining patients were classified as “subjects with hypertrabeculation.” So, in total, 36 patients were diagnosed as having NCCM by the criteria of

Discussion

Echocardiography is currently the reference standard for the diagnosis of NCCM,16 although this recently has been called into question.17 The most important conclusion of the present study is that RBR is an objective, quantitative, and reproducible functional criterion with good predictive value for the diagnosis of NCCM as established by expert opinion.

References (30)

  • S. Sen-Chowdhry et al.

    Left ventricular noncompaction and cardiomyopathy: cause, contributor, or epiphenomenon?

    Curr Opin Cardiol

    (2008)
  • N.B. Ingels et al.

    Relation between longitudinal, circumferential, and oblique shortening and torsional deformation in the left ventricle of the transplanted human heart

    Circ Res

    (1989)
  • A.T. Burns et al.

    Doin’ the twist: new tools for an old concept of myocardial function

    Heart (Br Card Soc)

    (2008)
  • B.M. van Dalen et al.

    Influence of the pattern of hypertrophy on left ventricular twist in hypertrophic cardiomyopathy

    Heart (Br Card Soc)

    (2009)
  • E. Nagel et al.

    Cardiac rotation and relaxation in patients with aortic valve stenosis

    Eur Heart J

    (2000)
  • Cited by (66)

    • Changes in strain parameters at different deterioration levels of left ventricular function: A cardiac magnetic resonance feature-tracking study of patients with left ventricular noncompaction

      2021, International Journal of Cardiology
      Citation Excerpt :

      The normal rotation pattern is characterized by a clockwise rotation at the base of the LV (negative value) and a counterclockwise rotation at the apical part of the LV (positive value). By rigid body rotation (RBR), we mean that the apical and basal parts of the LV rotated predominantly in the same direction [9]. The interobserver agreement of the two observers was tested regarding the threshold-based software module, the CMR feature-tracking and Petersen's criterion in ten randomly selected patients and ten controls.

    View all citing articles on Scopus
    View full text