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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2016, Vol. 10 Issue (4) : 499-506     DOI: 10.1007/s11684-016-0473-8
Incremental value of contrast echocardiography in the diagnosis of left ventricular noncompaction
Xiaoxiao Zhang1,Li Yuan1,2,Linli Qiu1,Yali Yang1,Qing Lv1,Lin Li1,Jing Wang1,Lin He1,Li Zhang1,Xinfang Wang1,Mingxing Xie1(),Xu Yu Jin2()
1. Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
2. Oxford Echo Core Lab, NDCLS, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Contrast echocardiography with left ventricular opacification (LVO) improves the definition of endocardium in two-dimensional echocardiography (2DE). This study was aimed to determine whether LVO offered added diagnostic value in noncompaction of left ventricular myocardium (NCVM). A total of 85 patients (40±20 years, 54 males) with suspected NCVM were subjected to transthoracic 2DE and LVO, and 40 healthy volunteers were examined with 2DE and assigned as control subjects. The location of NCVM, the thickness ratio of noncompacted to compacted myocardium (NCR), and the cavity size and ejection fraction of LV were quantified. Results revealed that NCVM was mainly located in the LV medium (53.2%), apical (46.2%) segments, and lateral wall (39.8%). The NCR obtained through LVO was greater than that detected through 2DE (4.2±1.3 vs. 3.3±1.2, P<0.001), and higher inter-correlations and less intra- and inter-observer variabilities were determined in the former than in the latter. The NCVM detection rates were also increased from 63.5% via 2DE to 83.5% via LVO and 89.4% via 2DE combined with LVO (2DE+ LVO) (P = 0.0004). The LV cavity size was greater and the LV ejection fraction (LVEF) was lower in the NCVM patients than in the control group (P<0.01). In the NCVM group, the LV cavity size was higher and the LVEF was lower in LVO than in 2DE (P<0.01). In conclusion, contrast echocardiography contributes significant sensitivity and reproducibility to routine transthoracic echocardiography in NCVM diagnosis. Therefore, this technique should be clinically performed to diagnose suspected NCVM.

Keywords echocardiography      left ventricular noncompaction cardiomyopathy      echo contrast media     
Corresponding Authors: Mingxing Xie,Xu Yu Jin   
Just Accepted Date: 14 September 2016   Online First Date: 25 October 2016    Issue Date: 01 December 2016
URL:     OR
Variables NC-2DE (n = 85) NC-LVO (n = 85) Normal 2DE (n = 40) P value
(NC-2DE vs. normal 2DE)
P value
vs. NC-2DE)
LVEDD (mm) 58.9±11.6* 65.2±7.8** 45±5.1 <0. 0001 0.002
LVEDV (ml) 121±11.5* 162±14.8** 95±14.8 0.0371 <0. 001
LVESD (mm) 43.0±3.44* 47.8±5.67** 33±4.0 0.0012 <0. 001
LVESV (ml) 74.3±3.94* 84.7±2.46** 44±4.4 <0.0001 <0. 001
LVEF (%) 40.8±13.2* 38.2±12.4** 65.6±7.1 0.0435 <0. 001
E/A ratio 0.82±0.32* 0.84+ 0.46 1.62±0.5 <0. 0001 0.225
NC ratio 3.33±1.17 4.16±1.32** N/A N/A <0. 001
Tab.1  Echo parameters in NCVM and normal groups
Fig.1  2DE and LVO images in a margin case. (A) No clear NCVM lesion was detected through conventional 2DE. (B) Deeply perfused intertrabecular recesses (arrows indicated) with blood flow communicating with the LV cavity were detected. (C and D) Intertrabecular recesses were filled with contrast microbubbles in apical 2-chamber and LV short-axis views (indicated by arrows).
Fig.2  Comparison of NCVM locations through 2DE and LVO. (A) Conventional 2DE revealed prominent trabeculations in NCVM in the lateral wall (arrows indicated). (B) Intertrabecular recesses were perfused with contrast agents and thus revealed NCVM in the lateral wall and apex through LVO (arrows indicated).
Fig.3  Distribution of NCVM lesions on 2DE and LVO. NCVM is predominantly localized in the apical and mid-ventricular segments and lateral wall. More segments were detected through LVO than through 2DE.
Intra-observer Inter-observer
CV (%) R (Pearson’s) ICC (95% CI) CV (%) R (Pearson’s) ICC (95% CI)
2DE 4.290% 0.966* 0.965 (0.944–0.979) 9.676% 0.925* 0.931 (0.891–0.958)
LVO 2.336% 0.995* 0.988 (0.981–0.993) 8.218% 0.986* 0.979 (0.966–0.993)
Tab.2  Intra- and inter-observer reproducibility for NCR
Fig.4  Inter- and intra-observer consistency assessment of the thickness ratio of noncompacted to compacted myocardium (NCR) through Bland–Altman plots.
Positive case Negative case Detection rate P
2DE 54 31 63.5%
LVO 71 14 83.5% 0.0127*
2DE+ LVO 76 9 89.4% <0.0001#
Tab.3  Comparison of the NCVM detection rates of 2DE, LVO, and 2DE+ LVO
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