Left Ventricular Noncompaction: A Disease in Search of a Definition

Cardiología, Stöllberger et al analyze the relation between gender and clinical, and morphologic characteristics in one of the broadest-ranging series of patients with left ventricular noncompaction in the literature.1 From 36 933 transthoracic echocardiograms performed over a period of 10 years, they identified 100 patients who fulfilled pre-established diagnostic criteria. In their laboratory, left ventricular noncompaction was diagnosed in 2.7 per 1000 studies (which cannot be considered equivalent to the prevalence of the disease in patients undergoing echocardiography because it includes repeat studies of individual patients). Men accounted for 70 % of patients, a figure similar to that reported elsewhere. Essentially, their findings are that the condition is more frequent in men, but hypertrabeculation is more prominent in women. Based on this observation, they formulate the following hypotheses to explain this greater frequency of the disease in men: a) that hereditary forms linked to the X chromosome exist; b) that more women die in the early stages of the disease and more men develop acquired forms; c) that remission is more common in women; and d) that there is a selection bias towards less indication for echocardiography in women with heart failure.1 Although all these hypotheses are valid, one further option should be seriously considered, namely that the diagnostic criteria used may be wholly inadequate, or inadequate for men, or for women. In hypertrophic cardiomyopathy something similar occurs. Despite being an autosomal dominant disorder of hereditary genetic origin, men dominate practically all series, representing approximately 60%-70 % of cases. However, women with hypertrophic cardiomyopath