Differentiating athlete’s heart from left ventricular non-compaction cardiomyopathy

Left ventricular non-compaction cardiomyopathy is a recently recognized heart muscle disorder, which remains incompletely understood. It was originally considered to be a congenital disorder resulting from disruption of the normal developmental process of myocardial compaction, but the evidence supporting this notion is lacking. Some experts have suggested that the entity is not a distinct cardiomyopathy but a morphological trait shared by many phenotypically distinct cardiomyopathies. Others have shown that left ventricular non-compaction may be acquired by cardiac remodelling. Gold standard diagnostic criteria are currently lacking and proposed imaging-based criteria have created an epidemic of over-diagnosis in low risk populations. Athletes suffer significant false-positive rates, and current evidence suggests that this entity may be related to cardiovascular adaptation to increased preload. This chapter describes the contemporary knowledge and current controversies regarding left ventricular non-compaction cardiomyopathy and how this can be differentiated from athlete’s heart.