Reversible De Novo Left Ventricular Trabeculations in Pregnant Women: Implications for the Diagnosis of Left Ventricular Non-Compaction in Low Risk Populations
Does the development of increased left ventricular (LV) trabeculations during pregnancy among women with an otherwise morphologically normal heart suggest a diagnosis of LV noncompaction?
A cohort of 102 primigravida pregnant women was evaluated longitudinally with a series of echocardiograms in the first trimester, third trimester, and post-partum. Echocardiograms were analyzed according to established guidelines. Increased LV trabeculations and a diagnosis of LV noncompaction were based on established criteria.
Pregnancy was associated with increased heart rate, stroke volume, and cardiac output, as well as increased LV volume and mass. During pregnancy, 26 (25.4%) women developed increased trabeculations. Eight women showed sufficient LV trabeculation to fulfill both Chin and Jenni criteria for LV noncompaction. During the post-partum follow-up period of 24 ± 3 months, 19 (73%) women had a complete resolution of increased trabeculation, and five had a marked reduction in the trabeculated layer.
The authors concluded that pregnancy induces de novo LV trabeculation in a significant proportion of women. The results suggest that LV trabeculations occur in response to increased LV loading conditions or other physiologic responses to pregnancy, and are not specific for LV noncompaction. Also, these factors should be considered when assessing individuals with LV increased trabeculations outside the context of symptoms of heart failure or familial cardiomyopathy.
LV noncompaction can be a cause of dilated cardiomyopathy, typically assessed using diagnostic criteria addressing noncompacted-to-compacted myocardium at end-systole (Jenni) or noncompacted-to-total myocardial thickness at end-diastole (Chin). However, imaging criteria consistent with LV noncompaction commonly are seen among athletes and pregnant women, and among patients with sickle cell and dilated cardiomyopathy. This study revealed that a substantial number of women with a morphologically normal heart develop increased trabeculations during pregnancy, and that the trabeculations fully or partially resolve after delivery. These data further reinforce that existing criteria for the diagnosis of LV noncompaction are not sufficiently specific, and should be taken in clinical context.
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