When and How to Agree in Disagreeing on the Diagnosis of Noncompaction by Echocardiography?

SEE PAGE 1252 L eft ventricular hypertrabeculation (LVHT), also known as noncompaction, is a clinical entity that has gained great visibility after its initial description in 1984 (1). Its relevance relates to the fact that it might have significant clinical implications, including malignant arrhythmias and sudden death. One of the most important challenges regarding LVHT is the clear differentiation of this condition from anatomic and structural variants that are present in the normal heart (2). Several investigators have tried to describe criteria that could help in the correct diagnosis. Echocardiography has been extensively used, but no uniformity has been achieved. From the initial studies of Chin et al. (3) and also Jenni et al. (4), several other studies have been published describing echocardiographic criteria. More recently, the introduction of cardiac magnetic resonance (CMR) (5), computed tomography scanning (6), and 3-dimensional echocardiography (7) have added accuracy to the diagnosis, but again, no unanimous criteria has so far been accepted by the scientific community. One of the problems with the correct diagnosis of LVHT is related to the fact that the overdiagnosis of the condition has been observed in many laboratories (8), because even though the existing echocardiographic and CMR criteria are useful in diagnosing LVHT in patients with clear phenotypic expression, the precise sensitivity and specificity of the criteria are still unknown, particularly in milder forms of LVHT, where the distinction from normal variants can