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Contact address: Roxana Cristina Rimbas MD, PhD, Department of Cardiology and Cardiovascular Surgery, Emergency University Hospital, 169 Splaiul Independentei, 050098, Bucharest, Romania. E-mail: roxana.rimbas@umfcd.ro 1 „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2 Department of Cardiology and Cardiovascular Surgery, Emergency University Hospital, Bucharest, Romania 3 Department of Radiology, Emergency University Hospital, Bucharest, Romania INTROduCTION LVNC is a cardiac phenotype characterized by a bilayered myocardium, consisting of a thin, compacted epicardial layer (compacted myocardium CM) and a much thicker, non-compacted endocardial layer (noncompacted myocardium NCM), with trabeculations and deep intertrabecular recesses1. It was classified as a distinct primary genetic cardiomyopathy by the American Heart Association in 2006, and as an unclassified car diomyopathy by the European Heart Association in 20081,2. According to last guidelines, cardiomyopathies are defined by structural and functional abnormalities of the ventricular myocardium that are unexplained by flow limiting coronary artery disease or abnormal loading conditions2. However, the current definition of LVNC does not mention the LV dysfunction as an absolute criterion, but only non-standardized morphological criteria3–7, thus creating multiple controversies. Chin et al.3 defined LVNC by echocardiography when CM/(NCM + CM) is ≤0.5, assessed at end-diastole on short-axis parasternal views. Jenni et al. redefined the Abstract: Left ventricular non-compaction (LVNC) is an increasingly recognized phenotype. The current definition of the LVNC does not mention LV dysfunction as an absolute criterion in addition to morphological criteria. LV dilatation and decreased LV ejection fraction (LVEF) are often late manifestations of the disease and correlate with the occurrence of cardiovascular complications. However, to define LVNC as a cardiomyopathy, functional criteria must be fulfilled, in addition to the morphological ones. Multimodality imaging, such as myocardial deformation and myocardial work analysis derived from speckle tracking echocardiography (STE), in combination with cardiac magnetic resonance (CMR) might improve diagnosis and characterization of non-compaction, exposing earlier signs of LV systolic dysfunction. We present two comparative cases of LVNC in order to highlight the idea of subclinical dysfunction even in apparently benign forms with preserved LVEF, and also the importance of multimodality imaging approach.

Functional assessment in left ventricular non-compaction cardiomyopathy in multimodality imaging era might improve the definition