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European Journal of Echocardiography Advance Access published online on April 28, 2008
European Journal of Echocardiography, doi:10.1093/ejechocard/jen151
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

An unusual case of angina pectoris: a patient with isolated non-compaction of the left ventricular myocardium

André L. Dabarian1, Charles Mady1, Carlos E. Rochitte2, Afonso A. Shiozaki2, Pedro A. Lemos3 and Vera Maria Cury Salemi1,*

1 Cardiomyopathy Unit, Heart Institute (InCor), University of Sao Paulo Medical School
2 Magnetic Resonance Section, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
3 Service of Invasive Cardiology, University of Sao Paulo Medical School, São Paulo, Brazil

Received 15 January 2008; accepted after revision 21 March 2008.

* Corresponding author: Tel: +55 11 35 56 98 12; fax: +55 11 35 56 98 12. E-mail address: verasalemi{at}uol.com.br/ carvera{at}incor.usp.br


  Abstract

A 29-year-old white woman with typical angina pectoris presented diastolic dysfunction and was suggestive of isolated non-compaction of the ventricular myocardium (INCM) by echocardiography. Cardiac catheterization disclosed normal coronary arteries. Cardiovascular magnetic resonance (CMR) depicted prominent left ventricular INCM areas with non-compaction/compaction ratio of 3.7, and dipiridamol CMR demonstrated global perfusion defect at stress and normal perfusion at rest. Adenosine-induced vasodilation showed subnormal coronary velocity flow reserve in the right, left circumflex, and left anterior descending coronary arteries. The evidence of our case indicates that patients with INCM may present angina pectoris and, probably, relative chronic myocardial ischaemia related to a impaired microvascular function is responsible for this symptom as demonstrated invasively here. It is a possible mechanism for progressive myocardial dysfunction seen in these patients.

Keywords: Cardiomyopathy; Angina pectoris; Diastole; Microcirculation; Magnetic resonance imaging


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