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[Dilated cardiomyopathy: indication and role of non-invasive instrumental evaluation]
Bruno Pinamonti1, Giuseppe Cacciatore
1Struttura Complessa di Cardiologia, Azienda Ospedaliera Ospedali Riuniti, Piazza Ospedale, 1 34100 Trieste. bpinamonti@hotmail.com
Insights
Echocardiography effectively evaluates dilated cardiomyopathy, but other heart conditions can mimic it. Unusual echocardiographic findings warrant further investigation for accurate diagnosis.
Area of Science:
- Cardiology
- Medical Imaging
Context:
- Echocardiography and echo-Doppler studies are standard for assessing dilated cardiomyopathy.
- Left ventricular dilation and systolic dysfunction can occur in various conditions mimicking idiopathic dilated cardiomyopathy.
Purpose:
- To highlight the diagnostic challenges in differentiating dilated cardiomyopathy from other cardiac diseases using echocardiography.
- To emphasize the importance of recognizing atypical echocardiographic findings.
Summary:
- Typical echocardiographic findings for dilated cardiomyopathy are well-established.
- Unusual findings like mild dilation, segmental wall motion abnormalities, or right ventricular dysfunction suggest alternative diagnoses.
- Invasive studies like coronary angiography and endomyocardial biopsy may be necessary for definitive diagnosis.
Impact:
- Improved diagnostic accuracy for dilated cardiomyopathy.
- Enhanced clinical suspicion for alternative diagnoses when echocardiographic findings are atypical.
- Guides appropriate utilization of advanced imaging and invasive procedures.
Abstract:
Typical morphological and functional abnormalities of dilated cardiomyopathy can be well evaluated non-invasively by the echocardiographic and echo-Doppler study. However it is important to remember that left ventricular dilation and depressed systolic function can be found also in other diseases that may mimic idiopathic dilated cardiomyopathy (coronary heart disease, myocarditis, biventricular dysplasia, advanced hypertrophic cardiomyopathy, hypertensive or valvular heart diseases). Unusual echocardiographic findings for dilated cardiomyopathy, i.e. a mildly dilated and/or hypertrophic left ventricle, segmental rather than diffuse wall motion abnormalities, predominant right ventricular dilation and dysfunction or severe valvular abnormalities should increase the clinical suspicion of a different disease. Transesophageal and dobutamine stress echocardiography can be employed in selected patients. However, for definitive diagnosis invasive hemodynamic study with coronary angiography and sometimes endomyocardial biopsy is often required. The diagnostic role of other non-invasive studies, such as magnetic resonance, computed tomography and nuclear techniques, is not well known, considering the cost and the limited availability of these clinical tools.