CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 5, June 2013
188
AFRICA
Letter to the Editor
Isolated left ventricular non-compaction in Africa:
elucidating myths
Dear Sir
We read with great interest the article by Falase
et al
. in the
November 2012 issue of this journal.
1
They stated that there
are no documented cases of left ventricular non-compaction in
Africa. Furthermore, they propose that this is due to a lack of
awareness of this condition among African cardiologists. The
purpose of this letter is to highlight that this statement is not
entirely accurate.
Isolated left ventricular non-compaction has been the subject
of several case reports
2,3
occurring in individuals of sub-Saharan
origin, as well as two large studies
4,6
(Table 1). The first large
study that documented this condition included 54 individuals, all
of African origin with no evidence of any congenital or acquired
heart conditions associated with the phenotype of left ventricular
non-compaction.
4
This study showed that using comprehensive
echocardiographic criteria could distinguish between normal
individuals and those with left ventricular non-compaction.
Furthermore, the burden of right ventricular non-compaction and
papillary muscle abnormality in this condition was highlighted
for the first time, which corresponds to findings from the
largest pathology study conducted thus far.
5
We also recently
described the myocardial mechanics of a cohort of subjects
who fulfilled the echocardiographic criteria for isolated left
ventricular non-compaction, with rigid body rotation occurring
in 53% of subjects.
6
It is important to note that currently, the only dedicated left
ventricular non-compaction clinic in the southern hemisphere is
based at the Chris Hani Baragwanath Hospital, where patients
have now been followed up for up to 40 months. This centre has
dealt with both national and international referrals, and offers
echocardiographic techniques and CMR to aid diagnosis. In
addition to standard medical therapy, patients with isolated left
ventricular non-compaction have been treated with biventricular
pacing and internal cardiac defibrillators in cases of refractory
heart failure.
Isolated left ventricular myocardium is a condition
encountered in clinical practice in Africa and needs to be
identified and distinguished from acquired causes of left
ventricular non-compaction. Long-term outcome and follow up
have not been documented among patients of African origin and
is the subject of future research initiatives.
FERANDE PETERS, MB BCH (Wits), FCP (SA), Cert
Cardiology (SA), FACC,
MOHAMED R ESSOP, MB BCH (Wits), FCP (SA), FACC
FRCP (UK)
References
1.
Falase AO, Ogah OS. Cardiomyopathy and myocardial disorders in
Africa: present status and the way forward.
Cardiovasc J Afr
2012;
23
(10): 552–562.
2.
Peters F, dos Santos C, Essop R. Isolated left ventricular non-compac-
tion with normal ejection fraction.
Cardiovasc J Afr
2011;
22
(2): 90–93
3.
Peters F, Khandheria BK, dos Santos C, Matioda H, Mogogane MT,
Essop MR. Isolated left ventricular noncompaction in identical twins.
Am J Cardiol
2012 Jun 27. [Epub ahead of print].
4.
Peters F, Khandheria BK, dos Santos C, Matioda H, Maharaj N,
Libhaber E, Mamdoo F, Essop MR. Isolated left ventricular noncom-
paction in sub-Saharan Africa: a clinical and echocardiographic
perspective.
Circ Cardiovasc Imaging
2012;
5
(2): 187–193.
5.
Burke A, Mont E, Kutys R, Virmani R. Left ventricular noncompac-
tion: a pathological study of 14 cases.
Hum Pathol
2005;
36
: 403–411.
6.
Peters F, Khandheria B, Libhaber E, Maharaj E, Matioda H, Essop MR.
Left ventricular twist in left ventricular noncompaction.
Eur Heart J
Cardiovasc Imaging
2013 (in press).
7.
Paule P, Braem L, Mioulet D, Jop B, Théron A, Gil JM, Héno P,
Fourcade L. Left ventricular non-compaction: a cardiomyopathy in
young individuals. Description of first cases in Africa.
Med Trop
(Mars)
2007;
67
(6): 587–593.
8.
Massoure PL, Lamblin G, Bertani A, Eve O, Kaiser E. Rare cause of
heart failure in an elderly woman in Djibouti: left ventricular non-
compaction.
Med Trop (Mars)
2011;
71
(5): 505–507.
TABLE 1. ISOLATED LEFTVENTRICULAR NON-COMPACTION IN INDIVIDUALS OF SUB-SAHARAN ORIGIN
Authors
Year of
publication
Type of report
Sample
size
Age (years) Imaging technique
Paule P, Braem L, Mioulet D, Jop B, Théron A,
Gil JM, Héno P, Fourcade L
7
2007
Case report
3 Range: 23–45 Echo and MRI
Massoure PL, Lamblin G, Bertani A, Eve O,
Kaiser E
8
2011
Case report
1
74
Echo
Peters F, dos Santos C, Essop R
2
2011
Case report
1
Echo: Jenni criteria
Peters F, Khandheria BK, dos Santos C, Matioda
H, Mogogane MT, Essop MR
3
2012
Case report
2
35
Echo: Jenni criteria
Peters F, Khandheria BK, dos Santos C, Matioda
H, Maharaj N, Libhaber E, Mamdoo F, Essop M
4
2012
Large prospective
series
54
Mean:
45.4
±
13.1
Comprehensive criteria: combination
of Jenni and Stolberger
Peters F, Khandheria BK, Libhaber E, Maharaj
N, dos Santos C, Matioda H, Essop MR
6
2013
Large prospective
series
60
Mean:
47.01
±
12.8
Comprehensive criteria: combination
of Jenni and Stollberger
