Left Ventricular Non-Compaction in Sub-Saharan Africa: Diagnostic Challenges and the Role of Echocardiography

Background: Left ventricular non-compaction (LVNC) is a rare congenital cardiomyopathy characterized by excessive trabeculations and deep intertrabecular recesses of the left ventricular myocardium. Although increasingly recognized worldwide, LVNC remains underdiagnosed in sub-Saharan Africa due to limited access to cardiac magnetic resonance imaging and insufficient familiarity with echocardiographic diagnostic criteria. Case Presentation: We report the case of a 50-year-old woman admitted for advanced heart failure in Brazzaville, Republic of Congo. She presented with New York Heart Association class IV dyspnea and a strong family history of heart failure and sudden cardiac death. Transthoracic echocardiography revealed severe left ventricular systolic dysfunction and typical features of LVNC, including prominent apical and lateral trabeculations with a non-compacted to compacted myocardial ratio of 2.6 at end-systole. Cardiac magnetic resonance imaging, performed subsequently, confirmed the diagnosis. Medical treatment resulted in marked clinical improvement. Conclusion: LVNC is likely underrecognized in sub-Saharan Africa. This case demonstrates that careful transthoracic echocardiography, combined with clinical and familial data, can allow a reliable diagnosis even in the absence of cardiac magnetic resonance imaging. Strengthening echocardiographic expertise is essential to improve the detection and management of LVNC in resource-limited settings.