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Case Report/Case Series |

Hypertrabeculation vs Left Ventricular Noncompaction on Echocardiogram:  A Reason to Restrict Athletic Participation?

David C. Peritz, MD1; Aaron Vaughn, MD2,3; Mario Ciocca, MD4; Eugene H. Chung, MD5
[+] Author Affiliations
1Department of Medicine/Pediatrics, University of North Carolina at Chapel Hill
2Department of Family Medicine, University of North Carolina at Chapel Hill
3Department of Sports Medicine, University of North Carolina at Chapel Hill
4Sports Medicine, Campus Health, University of North Carolina at Chapel Hill
5Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill
JAMA Intern Med. 2014;174(8):1379-1382. doi:10.1001/jamainternmed.2014.1066.
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Importance  Left ventricular noncompaction (LVNC) is a rare cause of progressive cardiomyopathy thought to result from incomplete myocardial development. It has been associated with an increased risk of sudden death, especially in those with a depressed left ventricular ejection fraction. Thus, the current recommendation for patients with this diagnosis is restriction from participation in competitive sports.

Observations  An asymptomatic 18-year-old African American collegiate football player had a murmur on his preparticipation physical examination. Subsequent cardiology workup revealed hypertrabeculation vs LVNC. Second and third opinions were sought from national experts in the field: one gave the diagnosis of LVNC and recommended restriction; the other gave the diagnosis of hypertrabeculation. After a family meeting including the player, mother, team physician, and consulting cardiologist, the player was permitted to participate in football.

Conclusions and Relevance  Distinguishing between pathologic LVNC and physiologic hypertrabeculation is a diagnostic challenge and is becoming increasingly commonplace with enhanced echocardiography and magnetic resonance imaging modalities. Given the limited data on such patients, careful workup and discussion between patient and providers is required.

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Figures

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Figure 1.
Electrocardiogram Performed at Initial Visit

Twelve-lead electrocardiogram showing sinus rhythm, sinus arrhythmia, anterior early repolarization pattern, inverted T wave in V1, and biphasic T wave in lead III.

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Figure 2.
Echocardiogram Revealing Hypertrabeculation but Normal Systolic Function

A, Increased ventricular wall thickness. The left ventricular ejection fraction is more than 55%. B, Prominent trabeculation of the apical portion of the left ventricle with deep intertrabecular recesses. Arrowhead in each view indicates area of hypertrabeculation.

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Figure 3.
Magnetic Resonance Imaging: Apical Hypertrabeculation Without Segmental Myocardial Thinning

Magnetic resonance image showing no apical thrombi and no evidence of systolic dysfunction. Arrowhead indicates area of hypertrabeculation.

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