Comparative Efficacy, Safety, and Periprocedural Thrombohemorrhagic Risk Stratification of Direct Oral Anticoagulants Versus Vitamin K Antagonists During Uninterrupted Anticoagulation Strategies for Catheter Ablation of Atrial AtriatFibrillation: An Updated Systematic Review anl and Network Meta-Analytical Synthesis of Contemporary Randomized and Real-World Evidence

Abstract Background Left ventricular non-compaction cardiomyopathy (LVNC) represents a morphologically heterogeneous myocardial disorder characterized by excessive trabeculation and deep intertrabecular recesses. Despite advances in multimodal imaging, the phenotypic definition and nosological classification of LVNC remain controversial. Objective To comprehensively characterize the morphofunctional, echocardiographic, and pathoanatomical spectrum of isolated LVNC and to evaluate imaging-based markers that support its recognition as a distinct genetic and structural cardiomyopathy. Methods This study integrates observational imaging data, histopathological correlation, and morphometric analysis derived from transthoracic echocardiography, three-dimensional2 echocardiography, speckle-tracking strain imaging, and contrast-enhanced echocardiography. Diagnostic performance, myocardial deformation indices, and trabecular complexity metrics were analyzed. Results LVNC demonstrated significant variability in trabecular distribution, myocardial deformation patterns, and ventricular remodeling phenotypes. Multimodal echocardiography improved diagnostic sensitivity and enabled detection of subclinical systolic dysfunction. Morphofunctional analysis identified distinct phenotypes associated with genetic cardiomyopathy patterns. Conclusion Multimodal echocardiographic characterization refines LVNC phenotyping and supports its classification as a distinct structural and genetic cardiomyopathy. Advanced imaging markers may improve early diagnosis, risk stratification, and therapeutic decision-making.