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Title: Left ventricular non-compaction : an inherited cardiomyopathy or a physiological response to increased pressure or volume overload?
Author: Gati, Sabiha
ISNI:       0000 0004 6057 6634
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2016
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Increased Left ventricular trabeculation is the morphological hallmark of left ventricular non-compaction (LVNC). Data from a dedicated heart failure clinic in the UK revealed that nearly 25% patients showed features consistent with LVNC. My study of over 1000 athletes revealed that 18% exhibited increased LV trabeculations and 8% fulfilled echocardiographic criteria for LVNC. Increased LV trabeculations were more common in black athletes (n=42, 28%). Furthermore, my clinical assessment of 99 patients with sickle cell anaemia showed that almost 10% fulfill echocardiographic criteria for LVNC. A common theme amongst all three cohorts is the presence of an increased cardiac preload. The main limitation of the studies described above is that they were cross-sectional in nature; therefore it was not possible to ascertain a definite association between increased LV trabeculations and cardiac loading states. I therefore, used a pregnancy model of a reversible increase in cardiac preload to determine whether LV trabeculation can be acquired from an otherwise morphological normal basal state. Pregnancy is generally associated with a doubling of cardiac volume by the end of the second trimester. Between 2010 and 2014, I performed a longitudinal echocardiographic analysis in 102 primigravida pregnant women in the first and third trimester, and post-partum. All women had morphologically normal hearts without any LV trabeculation at the beginning. Increased LV trabeculation and the presence of LVNC were based on established criteria. The research comprising the thesis was based at St George's Hospital NHS Trust and University Hospital Lewisham. Of the 102 pregnant women recruited to the study, 26 (25.4%) developed de novo trabeculations that were more common in black women compared with white women (36.1% v 18.1%; p=0.032). Eight percent fulfilled both the Chin and Jenni criterion for LVNC. In the post-partum period with a mean follow-up of 24±4 months, 18 (69%) women showed resolution of myocardial changes and 6 had a marked reduction in the trabeculated layer. One woman became pregnant again and was excluded from follow­ up. This thesis revealed that women with a morphologically normal LV develop increased LV trabeculations during pregnancy, which subsequently regressed post-partum. Black women had a greater magnitude of these changes compared with white women. An increased preload is a potential mechanism for increased trabeculations. The finding from this PhD should prevent erroneous over-diagnosis of LVNC in low risk populations outside the context of cardiac symptoms and familial cardiomyopathy.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available