Distinguishing ischemic cardiomyopathy from nonischemic dilated cardiomyopathy with coronary echocardiography

Abstract

Transthoracic echocardiographic examination of the proximal left coronary system was performed in 59 patients who had dilated cardiomyopathy to determine if this technique could distinguish between ischemic and nonischemic dilated cardiomyopathy. With use of annular array transducers (3.5 or 5 MHz) and digital image processing, echocardiographic visualization of the coronary arteries was successful in 55 (93%) of 59 patients. As assessed by coronary angiography, 32 subjects had ischemic cardiomyopathy and 27 had nonischemic cardiomyopathy. Twenty-seven (84%) of the 32 patients who had coronary artery disease and 24 (89%) of the 27 patients with nonischemic cardiomyopathy were correctly identified. The accuracy of coronary echocardiography was 86% in the entire study group and 93% when patients with inadequate studies were excluded. All subjects who had ischemic cardiomyopathy had evidence of disease by coronary echocardiography or segmental wall motion abnormalities. Multivariate analysis permitted correct classification of 93% of all subjects based on the results of the coronary echocardiogram, evaluation of segmental wall motion and a history of prior myocardial infarction. The correct diagnosis was made in 86% when the results of coronary echocardiography were excluded from analysis using all other echocardiographic and clinical variables. Transthoracic coronary echocardiography can be performed with a high degree of success in patients with dilated ventricles and the technique can reliably distinguish between ischemic and nonischemic dilated cardiomyopathy.

Association of Cardiomegaly with Coronary Artery Histopathology and its Relationship to Atheroma

“…It is assumed here that nearly all cases of ischemic cardiomyopathy should be eliminated by finding postmortem evidence of coronary thrombosis or visible ischemic lesions in the myocardium 2,3,17) . To the extent that this assumption may be false, the following conclusions must be viewed with caution.…”

“…Idiopathic dilated cardiomyopathy, clinically recognized, manifests dilated hypertrophy without anatomic cause, hypertension, or obesity [11][12][13] , and coronary arteries are generally thought to have little atherosclerosis [3][4][5][6][7][8][9][10][11][12][13] , although contrary evidence has been observed [12][13] . Recent studies applying newly introduced technologies for quantifying coronary artery calcifications have reported an increased extent of such plaques in relation to cardiac hypertrophy 2,6,[14][15][16] ; however, these studies in living patients were handicapped by the inability to clearly distinguish ischemia from other forms of cardiomyopathy. Whether hypertrophy can itself promote coronary plaques (rather than result from them) therefore remains a persistent question.…”

“…When the cause of hypertrophy is determined to be hypertension 6) , obesity [7][8][9][10] , or a combination of the two, then the coronary arteries are expected to display excessive sclerosis. Ischemic cardiomyopathy, clinically recognized, is said to occur upon finding significant coronary stenosis by angiography or noninvasive methods, whether or not this is confirmed by abnor-mal chamber wall motility [2][3] . Idiopathic dilated cardiomyopathy, clinically recognized, manifests dilated hypertrophy without anatomic cause, hypertension, or obesity [11][12][13] , and coronary arteries are generally thought to have little atherosclerosis [3][4][5][6][7][8][9][10][11][12][13] , although contrary evidence has been observed [12][13] .…”

“…The most common of these are ischemic, hypertensive, obesity-related, idiopathic dilated, and hypertrophic cardiomyopathy, as variably defined [1][2][3][4][5] . When the cause of hypertrophy is determined to be hypertension 6) , obesity [7][8][9][10] , or a combination of the two, then the coronary arteries are expected to display excessive sclerosis.…”

Dual source computed tomography coronary angiography in new onset cardiomyopathy

“…Thus, current guidelines recommend assessment for underlying obstructive CAD [8] , either through non-invasive testing or invasive X-ray coronary angiography (ICA). However, traditional noninvasive testing with nuclear imaging and echocardiography have not been shown to consistently differentiate between ischemic and nonischemic etiologies [9][10][11][12][13][14][15][16][17][18] , and patients are frequently referred for ICA. Coronary computed tomography angiography (CCTA) has been demonstrated in several studies to have excellent diagnostic accuracy for evaluating the presence of significant CAD [19,20] , particularly in unselected populations with no known CAD [21] .…”