Dear Jayanth Keshavamurthy, please explain to me. What is purpose to perform stress echo testing? The traditional diagnostic study for evaluation of LVNC is echocardiography.There are some disadvantages when using echocardiography for the assessment of LVNC. These include the inaccuracy of off-axis or oblique image planes and the challenges of evaluating the apex. These are overcome with skilled sonographers obtaining standard chamber views and the addition of contrast when the apex is not will visualized.The high resolution imaging of cardiac magnetic resonance  has allowed improvement in differentiating the noncompacted and compacted myocardium.

The initial study of choice remains echocardiography. Based on the current literature, we use the Jenni criteria with consideration of both the end-diastolic and end-systolic myocardial layer thickness. The Jenni criteria include a bilayered myocardium, a noncompacted to compacted ratio >2 : 1, communication with the intertrabecular space demonstrated by color Doppler, absence of coexisting cardiac abnormalities, and the presence of multiple prominent trabeculations in end-systole. If the diagnosis is indeterminate based on the echocardiogram, then additional imaging modalities should be performed. Contrast echocardiography may be applied to further define the trabeculations and endocardium for accurate measurement of the myocardial layers. If more information is needed, then a MRI may be the reasonable next test. MRI will also allow for the assessment of fibrosis. 

The reason I asked is. On a recent cardiac MRI request was falling EF gradually. Non compaction not caught on echo. Sress echo mentions possible ischemia. cardiac cath was clean. So I was interested if there is any article on stress echo wall motion d=findings in non compaction cardiomyopathy cases.

Thanks for your reply.

MRI is the gold standard for diagnosis of noncompaction cardiomyopathy. Stress echo probably have minimal role in diagnosis of noncompaction cardiomyopathy. Stress echo probably have some role in predicting contralile reserve in advanced stage of noncompaction cardiomyopathy. Speckle tracking strain echo and myocardial contrast echo have great role in differentiating between noncompaction cardiomyopathy,Hypertrophic cardiomyopathy and idiopathic DCM.. Ischaemic changes in stress echo in noncompaction in your case may be because of microvascular dysfunction... Thanks 

http://www.sciencedirect.com/science/article/pii/S2352906714000839

Thanks Biswajit.