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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Left ventricular non-compaction &#40;LVNC&#41; is morphologically characterized by excessive trabeculation of the left ventricular &#40;LV&#41; walls with deep intertrabecular recesses that communicate with the ventricular cavity but not with the coronary circulation&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">It is a relatively recently described anomaly&#44; still with many uncertainties and the subject of intense controversy and debate&#58; there is no consensus regarding disease pathophysiology&#44; classification or diagnostic criteria&#46; Additionally&#44; it is sometimes doubted whether this entity really exists as a single disease&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Though it has been thought to be a congenital heart disease resulting from incomplete morphogenesis of the endomyocardium&#44; another theory argues that it is possible to acquire LVNC during life&#46; Currently&#44; it is recognized that physiological and pathophysiological processes associated with increased LV preload and afterload &#40;including pregnancy&#44; sports&#44; chronic renal failure&#44; sickle cell disease and heart valve disease&#41; may lead to a cardiac morphology that also fulfills criteria for LVNC&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">LVNC is classified as a genetic cardiomyopathy by the American Heart Association&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a> whereas the European Society of Cardiology includes LVNC in the group of unclassified cardiomyopathies&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">However&#44; the most important and debated point of controversy concerns LVNC diagnostic criteria&#46; The most frequently used criteria are those of Jenni&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> who proposed the following&#58; &#40;1&#41; the existence of two layers&#44; one thin and compacted &#40;C&#41; and the other noncompacted &#40;NC&#41;&#44; and a ratio of NC&#47;C &#62;2 when measured in end-systole in parasternal short-axis view&#59; &#40;2&#41; absence of other structural cardiac anomalies&#59; &#40;3&#41; numerous&#44; excessively prominent trabeculations and deep intertrabecular recesses&#59; and &#40;4&#41; intertrabecular spaces perfused by blood flow demonstrated by color Doppler&#46; Chin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a> suggest as a diagnostic criterion an X-to-Y ratio &#8804;0&#46;5&#44; where X is the distance between the epicardial surface and trough of a trabecular recess and Y is the distance from the epicardial surface to the peak of the trabeculation&#44; as measured in images of the LV apex and free wall in end-diastole&#46; St&#246;llberger et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> propose as diagnostic criteria the existence of more than three trabeculations protruding from the LV wall&#44; apical to the papillary muscles&#44; visible in a single image plane&#44; and intertrabecular spaces perfused from the ventricular cavity&#44; visualized by color Doppler&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Cardiac magnetic resonance &#40;CMR&#41;&#44; with its excellent spatial resolution and good visualization of the LV apex&#44; also has an important role in diagnosing LVNC&#46; Petersen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> suggested as a criterion an NC&#47;C ratio of &#62;2&#46;3 in diastole&#46; On the other hand&#44; Jacquier et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> calculated the LV trabecular mass using steady-state free precession short-axis views and proposed a cut-off of LV trabecular mass above 20&#37; of the total LV mass as predictive of LVNC&#46; More recently&#44; Captur et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> described a new CMR tool&#44; fractal analysis&#44; which summarizes global LV trabecular complexity as a continuous variable termed fractal dimension&#59; a fractal dimension &#8805;1&#46;3 gave the optimal prediction for patients with LVNC&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The multiplicity of diagnostic criteria reflects the fact that none of them are fully satisfactory&#46; In fact&#44; in some cases we may be classifying as pathological a physiological adaptation to different load conditions&#46; On the other hand&#44; Kohli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> report that of 199 patients with LV systolic dysfunction&#44; 23&#46;6&#37; met at least one of three echocardiographic definitions of LVNC&#44; and suggest that the current criteria lack specificity&#46; LV dilatation and the increased sphericity typical of dilated cardiomyopathy can make trabeculae more evident and in this way lead to overdiagnosis of LVNC&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The broad clinical spectrum of disease ranges from asymptomatic patients&#44; with no family history&#44; normal LV ejection fraction&#44; normal ECG&#44; normal exercise capacity and excellent prognosis &#40;in whom it is questionable if they really have LVNC&#41; to the other extreme&#44; of patients presenting with chronic heart failure&#44; thromboembolic events&#44; severe ventricular arrhythmias and sudden cardiac death&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">It is clear that an intense research effort is still needed to achieve a better understanding of the pathophysiology of LVNC&#44; perhaps expanding knowledge of the disease to other cardiac chambers&#44; such as the atria&#46; A proper characterization of atrial mechanics could be important in detecting subclinical dysfunction in LVNC and also in differentiating between pathological and physiological conditions&#46; Furthermore&#44; as atrial enlargement and&#47;or dysfunction are recognized outcome predictors in many heart diseases&#44; it would be interesting to assess their prognostic power in LVNC&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Portuguese Journal of Cardiology</span>&#44; Nemes et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a> studied right atrial &#40;RA&#41; deformation in LVNC patients with three-dimensional speckle tracking echocardiography &#40;3D-STE&#41;&#46; Although they identified atrial volume differences between LVNC patients and controls&#44; they were unable to detect significant differences in RA deformation parameters between the two groups&#44; suggesting that RA mechanics is preserved in LVNC&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">These results are in strong contrast to a previous study from the same group&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a> also with 3D-STE in LVNC patients but focusing on the left atrium &#40;LA&#41;&#46; In that study&#44; the authors found &#40;together with increased LA volumes and decreased LA emptying fractions&#41; a significant reduction in LA deformation parameters in LVNC patients&#44; showing significant deterioration in all the different components of LA function in LVNC&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">This work represents one more step towards a better understanding of LVNC&#44; suggesting that RA dysfunction plays a minor role in LVNC and indicating that future investigation in this disease should remain focused mainly on the left heart chambers&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">To summarize&#44; this paper is useful to compact knowledge in left ventricular non-compaction&#46; Please&#44; study the left heart in a left ventricular disease&#33;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Compacting knowledge in left ventricular non-compaction
Compactar o conhecimento na não compactação ventricular esquerda
Alexandra Toste, Nuno Cardim
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ncardim@hospitaldaluz.pt

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Multimodality Cardiac Imaging Department, Hospital da Luz, Lisbon, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Left ventricular non-compaction &#40;LVNC&#41; is morphologically characterized by excessive trabeculation of the left ventricular &#40;LV&#41; walls with deep intertrabecular recesses that communicate with the ventricular cavity but not with the coronary circulation&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">It is a relatively recently described anomaly&#44; still with many uncertainties and the subject of intense controversy and debate&#58; there is no consensus regarding disease pathophysiology&#44; classification or diagnostic criteria&#46; Additionally&#44; it is sometimes doubted whether this entity really exists as a single disease&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Though it has been thought to be a congenital heart disease resulting from incomplete morphogenesis of the endomyocardium&#44; another theory argues that it is possible to acquire LVNC during life&#46; Currently&#44; it is recognized that physiological and pathophysiological processes associated with increased LV preload and afterload &#40;including pregnancy&#44; sports&#44; chronic renal failure&#44; sickle cell disease and heart valve disease&#41; may lead to a cardiac morphology that also fulfills criteria for LVNC&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">LVNC is classified as a genetic cardiomyopathy by the American Heart Association&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a> whereas the European Society of Cardiology includes LVNC in the group of unclassified cardiomyopathies&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">However&#44; the most important and debated point of controversy concerns LVNC diagnostic criteria&#46; The most frequently used criteria are those of Jenni&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> who proposed the following&#58; &#40;1&#41; the existence of two layers&#44; one thin and compacted &#40;C&#41; and the other noncompacted &#40;NC&#41;&#44; and a ratio of NC&#47;C &#62;2 when measured in end-systole in parasternal short-axis view&#59; &#40;2&#41; absence of other structural cardiac anomalies&#59; &#40;3&#41; numerous&#44; excessively prominent trabeculations and deep intertrabecular recesses&#59; and &#40;4&#41; intertrabecular spaces perfused by blood flow demonstrated by color Doppler&#46; Chin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a> suggest as a diagnostic criterion an X-to-Y ratio &#8804;0&#46;5&#44; where X is the distance between the epicardial surface and trough of a trabecular recess and Y is the distance from the epicardial surface to the peak of the trabeculation&#44; as measured in images of the LV apex and free wall in end-diastole&#46; St&#246;llberger et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> propose as diagnostic criteria the existence of more than three trabeculations protruding from the LV wall&#44; apical to the papillary muscles&#44; visible in a single image plane&#44; and intertrabecular spaces perfused from the ventricular cavity&#44; visualized by color Doppler&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Cardiac magnetic resonance &#40;CMR&#41;&#44; with its excellent spatial resolution and good visualization of the LV apex&#44; also has an important role in diagnosing LVNC&#46; Petersen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> suggested as a criterion an NC&#47;C ratio of &#62;2&#46;3 in diastole&#46; On the other hand&#44; Jacquier et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> calculated the LV trabecular mass using steady-state free precession short-axis views and proposed a cut-off of LV trabecular mass above 20&#37; of the total LV mass as predictive of LVNC&#46; More recently&#44; Captur et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> described a new CMR tool&#44; fractal analysis&#44; which summarizes global LV trabecular complexity as a continuous variable termed fractal dimension&#59; a fractal dimension &#8805;1&#46;3 gave the optimal prediction for patients with LVNC&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The multiplicity of diagnostic criteria reflects the fact that none of them are fully satisfactory&#46; In fact&#44; in some cases we may be classifying as pathological a physiological adaptation to different load conditions&#46; On the other hand&#44; Kohli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> report that of 199 patients with LV systolic dysfunction&#44; 23&#46;6&#37; met at least one of three echocardiographic definitions of LVNC&#44; and suggest that the current criteria lack specificity&#46; LV dilatation and the increased sphericity typical of dilated cardiomyopathy can make trabeculae more evident and in this way lead to overdiagnosis of LVNC&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The broad clinical spectrum of disease ranges from asymptomatic patients&#44; with no family history&#44; normal LV ejection fraction&#44; normal ECG&#44; normal exercise capacity and excellent prognosis &#40;in whom it is questionable if they really have LVNC&#41; to the other extreme&#44; of patients presenting with chronic heart failure&#44; thromboembolic events&#44; severe ventricular arrhythmias and sudden cardiac death&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">It is clear that an intense research effort is still needed to achieve a better understanding of the pathophysiology of LVNC&#44; perhaps expanding knowledge of the disease to other cardiac chambers&#44; such as the atria&#46; A proper characterization of atrial mechanics could be important in detecting subclinical dysfunction in LVNC and also in differentiating between pathological and physiological conditions&#46; Furthermore&#44; as atrial enlargement and&#47;or dysfunction are recognized outcome predictors in many heart diseases&#44; it would be interesting to assess their prognostic power in LVNC&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Portuguese Journal of Cardiology</span>&#44; Nemes et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a> studied right atrial &#40;RA&#41; deformation in LVNC patients with three-dimensional speckle tracking echocardiography &#40;3D-STE&#41;&#46; Although they identified atrial volume differences between LVNC patients and controls&#44; they were unable to detect significant differences in RA deformation parameters between the two groups&#44; suggesting that RA mechanics is preserved in LVNC&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">These results are in strong contrast to a previous study from the same group&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a> also with 3D-STE in LVNC patients but focusing on the left atrium &#40;LA&#41;&#46; In that study&#44; the authors found &#40;together with increased LA volumes and decreased LA emptying fractions&#41; a significant reduction in LA deformation parameters in LVNC patients&#44; showing significant deterioration in all the different components of LA function in LVNC&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">This work represents one more step towards a better understanding of LVNC&#44; suggesting that RA dysfunction plays a minor role in LVNC and indicating that future investigation in this disease should remain focused mainly on the left heart chambers&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">To summarize&#44; this paper is useful to compact knowledge in left ventricular non-compaction&#46; Please&#44; study the left heart in a left ventricular disease&#33;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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2022 Novembro 34 27 61
2022 Outubro 23 17 40
2022 Setembro 26 31 57
2022 Agosto 30 34 64
2022 Julho 26 30 56
2022 Junho 18 26 44
2022 Maio 21 21 42
2022 Abril 36 31 67
2022 Maro 26 37 63
2022 Fevereiro 14 23 37
2022 Janeiro 27 17 44
2021 Dezembro 24 24 48
2021 Novembro 33 35 68
2021 Outubro 35 41 76
2021 Setembro 16 26 42
2021 Agosto 29 32 61
2021 Julho 23 28 51
2021 Junho 20 22 42
2021 Maio 31 32 63
2021 Abril 40 65 105
2021 Maro 71 16 87
2021 Fevereiro 39 12 51
2021 Janeiro 34 20 54
2020 Dezembro 33 14 47
2020 Novembro 32 28 60
2020 Outubro 40 18 58
2020 Setembro 44 11 55
2020 Agosto 32 8 40
2020 Julho 40 14 54
2020 Junho 54 17 71
2020 Maio 33 2 35
2020 Abril 37 13 50
2020 Maro 42 11 53
2020 Fevereiro 65 21 86
2020 Janeiro 52 11 63
2019 Dezembro 26 13 39
2019 Novembro 46 9 55
2019 Outubro 29 6 35
2019 Setembro 31 8 39
2019 Agosto 35 13 48
2019 Julho 30 7 37
2019 Junho 30 23 53
2019 Maio 38 12 50
2019 Abril 27 13 40
2019 Maro 42 15 57
2019 Fevereiro 64 12 76
2019 Janeiro 60 7 67
2018 Dezembro 72 10 82
2018 Novembro 97 28 125
2018 Outubro 167 19 186
2018 Setembro 35 8 43
2018 Agosto 29 9 38
2018 Julho 25 7 32
2018 Junho 33 5 38
2018 Maio 50 14 64
2018 Abril 42 3 45
2018 Maro 64 12 76
2018 Fevereiro 36 6 42
2018 Janeiro 65 6 71
2017 Dezembro 108 15 123
2017 Novembro 47 10 57
2017 Outubro 27 11 38
2017 Setembro 21 11 32
2017 Agosto 26 8 34
2017 Julho 19 10 29
2017 Junho 24 6 30
2017 Maio 19 8 27
2017 Abril 17 4 21
2017 Maro 21 5 26
2017 Fevereiro 13 11 24
2017 Janeiro 19 10 29
2016 Dezembro 37 29 66
2016 Novembro 31 19 50
2016 Outubro 66 72 138
2016 Setembro 31 48 79
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