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LV non-compaction on echocardiography

A thick spongy layer of trabeculations with deep recesses at the apex and lateral wall, over a thin compacted layer.

Watch it in the simulator →Practise random cases

Where to look

Apical 4-chamber and PSAX at mid and apical level, ideally in systole when the two layers are easiest to measure.

Typical wall-motion pattern

Example: LV non-compaction

Hypokinetic: segments 10, 11, 12, 13, 14, 15, 16, 17

EF in this example: 54% (Borderline low (50–54%)).

1 Normal2 Hypokinetic3 Akinetic4 Dyskinetic5 Aneurysmal

Ejection fraction

Across 24 simulated cases of this pattern the true EF ranged from 50% to 59% (median 54%, Borderline low (50–54%)). Every case in the simulator is different, so practise until your visual estimate lands in the right 5% range.

Teaching points

Non-compaction: a thick, spongy trabeculated inner layer with deep recesses (apical/lateral), thin compacted outer layer (NC:C > 2 in systole). Often with reduced function.
Atrial fibrillation: filling and EF vary from beat to beat. Average at least five beats, or use an index beat (one that follows two similar RR intervals), and avoid beats after a very short RR interval.
Ventricular ectopics: the premature beat is weak and dyssynchronous and the beat after the pause is stronger. Judge EF and wall motion on normal sinus beats only.

Common pitfalls

Prominent normal trabeculations, false tendons and apical thrombus can mimic non-compaction. Look for two distinct layers with deep recesses.

Try it now: open the LV non-compaction example with the segment overlay, then test yourself in Practice where cases are random and graded against the exact answer.