Differentiation between Ischemic and Idiopathic Cardiomyopathies: Right Ventricular Two-dimensional Strain Imaging

Differentiating the two main causes of chronic heart failure, is crucial for proper management. Since, in idiopathic dilated cardiomyopathy (DCM), both ventricles are affected, whereas the left ventricle is involved mainly in ischemic cardiomyopathy (ICM), assessment of right ventricle (RV) function may be beneficial in such differentiation. Strain imaging is a handy tool that can be used for such differentiation.

The aim of this study was to differentiate between DCM and ICM using RV two-dimensional strain imaging.

One hundred and fifty patients were included in the study; according to the result of the echo-Doppler study and coronary angiography, they were divided into three equal groups: ICM group, DCM group, and a control group, matched in age and sex.

There was a statistically significant higher tricuspid annular plane systolic excursion (14.3 ± 3.5 mm vs. 12.62 ± 3.5 mm, P = 0.006) and tricuspid annular systolic velocity (Sa) (0.96 ± 0.02 m/s vs. 0.67 ± 0.02 m/s, P = 0.001) in the ICM group compared with the DCM group. GRVLS was statistically significantly lower in the DCM group compared to the ICM group (-14.23% ± 4.11) versus (-16.64% ±5.99) (P = 0.006). According to the receiver operating characteristic (ROC) curve analysis, tricuspid annular (S) velocity with cutoff value >0.09 m/s with 84% sensitivity and 70% specificity and GRVLS >-18%, with 88% sensitivity and 74% specificity can be used to distinguish ischemic etiology.

RV dysfunction is more evident in patients with idiopathic cardiomyopathy than in patients with ICM as proved by tissue Doppler imaging and RV strain imaging.