Introduction: Left ventricular nonconpaction (LVNC) is classified as primary cardiomyopathy. Because of its poor outcome, the diagnosis of LVNC is important. However, not all LVNC patient could be diagnosed only by echocardiography mostly due to the limitation in obtaining reliable apex image. We experienced a LVNC patient who could be diagnosed using the multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in addition to echocardiography. Case: A 48 year-old male was admitted to our hospital because of left paralysis and NYHA 4 exertional breathlessness. He was diagnosed cerebral infarction (CI) and acute heart failure (AHF) accompanying tachycardiac atrial fibrillation (AF). AHF was compensated by carvedilol, enalapril with LV ejection fraction improvement from 22% to 61%. Echocardiography revealed dilated cardiomyopathy like heart and non-compacted layer in lateral side of apex even though the diagnostic image for LVNC could not be obtained. We conducted MDCT and MRI to obtain clear tangent image at apex; and diagnosed LVNC with the non-compaction/compaction ratio of 2.8, 3.5 respectively. The anticoagulant therapy and optical medical therapy were continued even after AF eradication by pulmonary vein isolation, this patient has spent 6 months free from any adverse cardiovascular events. Conclusion: MDCT and MRI should be considered when echocardiography cannot provide diagnostic image for LVNC.
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