THE CARDIOMYOPATHY THAT NO LONGER EXISTS: THE EVOLVING APPROACH TO LEFT VENTRICULAR NONCOMPACTION ILLUSTRATED BY THE CASE OF A FLIGHT TECHNICIAN

Abstract: For decades, left ventricular hypertrabeculation was regarded as a rare congenital cardiomyopathy characterized by an excessively developed trabecular endocardial layer with deep intertrabecular recesses. It most commonly presented with heart failure, arrhythmias, and/or thromboembolic complications in young adults. Temporary or permanent suspension from flying duties was the usual response to a diagnosis of left ventricular noncompaction (LVNC) cardiomyopathy, given the potential risk of arrhythmia and sudden in-flight incapacitation. However, the 2023 European Society of Cardiology (ESC) guidelines have radically changed the approach to this imaging phenotype. Hypertrabeculation is no longer classified as a separate cardiomyopathy but as a phenotypic trait that may occur in isolation or accompany other heart conditions. This fundamental change in classification calls for a reassessment of existing aeromedical certification procedures and may affect the ability of aircrew previously disqualified on these grounds to continue their careers. The practical implications of this reclassification are illustrated by the case of a 41-year-old flight technician with left ventricular hypertrabeculation. In the era of “the cardiomyopathy that no longer exists,” this case underscores the importance of individual risk assessment and the need to adapt certification procedures to current medical knowledge.