- Oral presentation
- Open Access
A new definition of left ventricular compaction/noncompaction - the new gold-standard?
© Captur et al; licensee BioMed Central Ltd. 2013
- Published: 30 January 2013
- High Education Fund
- Ventricular Noncompaction
- Myocardial Compaction
- High Education Fund Council
- Left Ventricular Noncompaction
Abundant, abnormal myocardial trabeculae define left ventricular noncompaction (LVNC) but measurement is difficult and at least 5 techniques are described. We hypothesized that part of the reason for difficulties was that LV trabeculae were fractal in nature and beyond the simple geometry of 1 or 2 dimensional (2D) measurement. We designed and validated a new, rapid, clinically applicable method of measuring LV trabeculae based on fractal analysis.
We developed a fractal analysis technique for measuring LV trabeculation using CMR volume stack images.
All 135 human hearts were analyzable (average analysis time: 5.3±0.4 minutes per subject). The FDs of whole human hearts were: LVNC, 1.29±0.007; healthy black, 1.25±0.006; healthy white, 1.23±0.003, P value <0.001 for trend and pairwise comparisons. Across the heart there was a characteristic base-to-apex FD gradient. This was lost in LVNC (Figure-2b) so the maximal difference was noted in the apical third (maximal apical FD: LVNC, 1.391±0.010; black volunteers, 1.253±0.005; white volunteers, 1.235±0.004; P<0.0001). A maximal apical FD cut-off of ≥1.30, predicted LVNC with a high degree of accuracy, AUC 1.0. Normal reference ranges were created for black and white populations. Reproducibility analysis showed the fractal technique to be substantially more reproducible than other CMR methods.
A fractal-based approach to measuring LV trabeculae is mathematically sound, reproducible, clinically feasible and for the first time, validated against embryonic myocardial compaction. It describes trabeculation as a novel continuous variable, distinguishing health from disease but also detecting more subtle inter-ethnic differences.
J.C.M is supported by the Higher Education Funding Council for England.
T.M. is supported by funding from the Medical Research Council (U117562103).
Funding for development of high-resolution episcopic microscopy of embryos (http://www.embryoimaging.org) was provided by the Wellcome Trust (WT087743MA).
G.C. is supported by the University College London through a Graduate Research Scholarship and by the European Union through a Science and Technology Grant.
This work was undertaken at the University College London Hospital and University College London, which receive a proportion of funding from the Department of Health's National Institute for Health Research Biomedical Research Centres funding scheme.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.