Left Ventricular Noncompaction: A Rare Cause of Effort Angina Unveiled During Left Heart Catheterization

Key words: cardiac imaging, effort angina

A 47-year-old female with a 3-month history of effort angina and dyspnea in association with a recent positive treadmill exercise test was referred for left heart catheterization. Coronary angiogram showed no coronary artery disease. The interventional cardiologist decided to perform cardiac ventriculography, which revealed a “sawtooth” pattern of the inferior ventricular wall (Figures 1A.1 and 1A.2) and mildly reduced left ventricular ejection fraction.

Contrast-enhanced transthoracic echocardiogram showed prominent trabeculations with deep recesses involving predominantly the mid-basal left ventricular inferior wall, fulfilling criteria for left ventricular noncompaction (LVNC) (Figure 1B). A similar pathologic pattern was revealed by cardiac magnetic resonance (Figure 1C), which also showed subepicardial late gadolinium enhancement in the inferolateral wall. The patient was started on heart failure medication and referred to a specialized consultation.

Effort angina is an under-appreciated presentation of LVNC that frequently leads to a late diagnosis. This condition may be initially suspected when a cardiac ventriculography is performed. Decreased coronary flow reserve arising from under-developed microcirculation and/or compression of the intramural vasculature may be the mechanisms responsible for angina in these patients.

From the Department of Cardiology, Leiria Hospital Centre, Leiria, Portugal.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted March 28, 2019.

Address for correspondence: Luís Graça Santos, Department of Cardiology, Leiria Hospital Centre – Rua Santo André 2410-197, Leiria (Portugal). Email: luismscp1@gmail.com