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Misclassification of recovery in dilated cardiomyopathy by echocardiography as compared to cardiac MRI

David Mui1, Yuanwei Xu2, Neal K Pohlman3

  • 1Stanford School of Medicine, Stanford University, Stanford, CA, USA.

The International Journal of Cardiovascular Imaging
|August 21, 2025
PubMed

Insights

Cardiovascular magnetic resonance (CMR) provides more accurate measurements of cardiac function than 2D transthoracic echocardiography (TTE) in dilated cardiomyopathy (DCM) patients. TTE overestimates ejection fraction, leading to significant misclassification of heart failure status and recovery.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Heart Failure Research

Background:

  • Accurate assessment of cardiac function is crucial for diagnosing and managing dilated cardiomyopathy (DCM).
  • Cardiovascular magnetic resonance (CMR) and 2D transthoracic echocardiography (TTE) are used to assess cardiac function, but their comparative impact on heart failure (HF) classification and ejection fraction (EF) improvement assessment in DCM is not fully understood.

Purpose of the Study:

  • To compare left ventricular (LV) ejection fraction (EF) and volumes measured by CMR and 2D-TTE in DCM patients.
  • To evaluate the impact of these measurement differences on initial HF classification and subsequent assessment of myocardial recovery.

Main Methods:

  • Comparison of LV ejection fraction (LVEF), LV end-diastolic volume (LVEDV), and LV end-systolic volume (LVESV) from 130 DCM patients using CMR and 2D-TTE.
  • Assessment of myocardial recovery in patients with improved EF (HFimpEF) based on both imaging modalities over a 12-48 month follow-up period.

Main Results:

  • 2D-TTE significantly overestimated LVEF (8.3%) and underestimated LVEDV (-69.0 ml) and LVESV (-64.8 ml) compared to CMR.
  • The overestimation of LVEF by TTE was more pronounced at lower EF values.
  • This led to initial misclassification of 60% of heart failure with reduced ejection fraction (HFrEF) patients and misclassification of myocardial recovery in 59% of DCM patients.

Conclusions:

  • 2D-TTE measurements can lead to significant misclassification of heart failure status and myocardial recovery in DCM patients.
  • These discrepancies may impact initial treatment decisions and long-term patient management.
  • CMR offers a more accurate assessment of cardiac function in DCM, crucial for precise HF classification and monitoring treatment efficacy.

Keywords:
Cardiovascular magnetic resonanceDilated cardiomyopathyMyocardial recoveryTransthoracic echocardiography

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