case_images: PMC9120606_01
case_images: Brain magnetic resonance imaging. (A) Axial and (B,C) sagittal views in FLAIR sequence showing demyelinating lesions consistent with multiple sclerosis: perpendicular to the lateral ventricles (A), periventricular (B), and corpus callosum (C) (white arrows). (D) Twelve-lead electrocardiogram showing sinus tachycardia (125 beats/min), left atrial dilatation [P mitrale in II, and deepening of the terminal negative portion of the P wave in V1 (black arrows)] and left bundle branch block [QRS duration of >120 ms (blue arrow), lead V1 with a dominant deep S wave (green arrow); broad, notched R wave in V6 and I, and monophasic R wave in aVL (red arrows)]. ms, milliseconds.
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case_images: F1
case_images: Her past medical history revealed a history of relapsing-remitting MS (Figures 1A-C) diagnosed 15 years ago and treated with azathioprine and prednisone. The electrocardiogram (ECG) showed sinus tachycardia and complete left bundle branch block (LBBB) (Figure 1D).
case_images: Transthoracic echocardiogram. (A) Parasternal short axis of the mid left ventricle demonstrating two-layer myocardial structure, with a ratio of ticker non-compacted (redline) to thin compacted (yellow line) myocardium >2 at end-systole in the inferolateral segment. (B) Flow between intertrabecular recesses by intraventricular blood on color Doppler (white arrows). (C) Reduced global longitudinal strain (-6.5%). (D) Two-chamber view showing a regional deformation pattern with a markedly decreased myocardial deformation in apical segments (green and purple curves) in comparison to basal segments (red and yellow curves). Coronary angiography: coronary arteries without lesions (E,F) (white arrows). LCA, left coronary artery; LCx, left circumflex coronary artery; LM, left main coronary artery; LV, left ventricle; RCA, right coronary artery.
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case_images: F2
case_images: Transthoracic echocardiogram (TTE) demonstrated a left ventricular ejection fraction (LVEF) of 30%, mildly dilated, diffusely hypokinetic, prominent trabeculations of LV, and a non-compacted to compacted (NC/C) myocardium ratio of 2.75 in end-systole at inferolateral mid-ventricular level (Figures 2A-D), so the diagnosis of NCCM was realized. On the sixth hospital day, coronary angiography revealed that coronary arteries were normal (Figures 2E,F).
case_images: Cardiac MRI. (A) Short axis, (B) 4-chamber, and (C) 2-chamber views showing representative measurements of the ratio of ticker non-compacted (redlines) to thin compacted (yellow lines) myocardium >2.3 at end-diastole, in the (A) mid-inferolateral, (B) mid-anterolateral, and (A,C) mid-inferior segments. LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.
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case_images: F3
case_images: Cardiovascular magnetic resonance (CMR) imaging was performed 1 month after discharge to confirm the diagnosis and demonstrated positive diagnostic criteria for NCCM; additionally, the study did not show late gadolinium enhancement (LGE) (Figure 3).
case_images: The timeline of events. CMR, cardiac magnetic resonance; LV, left ventricle; LVEF, left ventricular ejection fraction; NC/C, non-compacted to compacted; NYHA, New York Heart Association; TTE, transthoracic echocardiogram.
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case_images: F4
case_images: ADHF. A timeline is showcased in Figure 4.