Cardiologists Argue It's Time to Abandon the Left Ventricular Noncompaction Diagnosis
Leading cardiac researchers challenge LVNC as a valid diagnosis, arguing the morphological pattern is a flawed basis for clinical decision-making.
Summary
A perspective piece published in the Journal of the American College of Cardiology from Imperial College London researchers argues that left ventricular noncompaction (LVNC) — a diagnosis based on the appearance of prominent trabeculations in the heart's left ventricle — should be retired. The authors contend that the diagnostic criteria are unreliable, leading to overdiagnosis in healthy individuals including athletes and pregnant women, while also failing to predict outcomes meaningfully. Rather than representing a distinct cardiomyopathy, the trabecular pattern associated with LVNC appears to be a nonspecific morphological trait influenced by genetics, physiology, and imaging technique. The authors suggest clinical management should instead focus on underlying genetic causes and functional cardiac assessment rather than the morphological label itself.
Detailed Summary
Left ventricular noncompaction (LVNC) has been classified as a distinct cardiomyopathy for decades, defined by excessive trabeculations — finger-like projections — in the left ventricular wall visible on cardiac imaging. However, a provocative new perspective from researchers at Imperial College London, published in the Journal of the American College of Cardiology, argues that this diagnosis is fundamentally flawed and should be retired from clinical practice.
The core problem, as the authors see it, is that the morphological criteria used to diagnose LVNC are neither specific nor reproducible. The same trabecular patterns are commonly observed in healthy athletes, pregnant women, and individuals of African ancestry — populations with no underlying cardiomyopathy. This has led to widespread overdiagnosis, with patients receiving a serious cardiac label based on an imaging finding that may be entirely benign.
Furthermore, the authors argue that LVNC does not behave as a discrete disease entity. Outcomes among patients diagnosed with LVNC vary enormously, largely because the label encompasses individuals with very different underlying conditions — from pathogenic genetic variants in sarcomere or cytoskeletal genes to entirely normal cardiac physiology. The trabecular appearance itself adds little prognostic value beyond what is already captured by ventricular function and genetic testing.
The clinical implications are significant. Patients diagnosed with LVNC may face unnecessary restrictions, anxiety, and interventions — including implantable defibrillators or anticoagulation — based on a morphological pattern rather than true disease risk. The authors advocate for shifting focus toward identifying causative genetic variants and assessing cardiac function directly.
This perspective challenges a long-standing diagnostic category and calls for a fundamental rethink of how trabecular morphology is interpreted in cardiology. If adopted, it could spare many patients from misdiagnosis while improving care for those with genuine underlying cardiomyopathies.
Key Findings
- LVNC diagnostic criteria are unreliable and frequently identify healthy individuals as having cardiomyopathy.
- Prominent trabeculations are common in athletes, pregnant women, and people of African ancestry without disease.
- LVNC does not represent a discrete cardiomyopathy — outcomes depend on underlying genetics and function, not morphology.
- Retiring the LVNC label could prevent unnecessary interventions, restrictions, and patient anxiety.
- Clinical focus should shift to genetic testing and ventricular function rather than trabecular appearance.
Methodology
This is an expert perspective or opinion article published in JACC, not an original research study with a primary dataset. The authors draw on existing literature, genetic evidence, and clinical experience to build their argument. As a perspective piece, it synthesizes prior studies rather than presenting new empirical findings.
Study Limitations
This summary is based on the abstract and publication metadata only, as the full text is not open access; the full depth of the authors' arguments and cited evidence cannot be fully assessed. As an opinion/perspective piece, the conclusions reflect expert interpretation rather than new empirical data, and may be contested by other cardiologists who support retaining the LVNC classification.
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