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ECG differentiation of idiopathic dilated cardiomyopathy from coronary artery disease with left ventricular
Y Momiyama1, H Mitamura, M Kimura
1Department of Cardiology, Tokyo Saiseikai Central Hospital, Japan.
Insights
Electrocardiogram (ECG) analysis reveals distinct patterns differentiating dilated cardiomyopathy (DCM) from coronary artery disease (CAD) with left ventricular (LV) dysfunction. Specific voltage ratios, particularly RV6/Rmax, show high diagnostic value for DCM.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Electrocardiography
Background:
- Distinguishing between dilated cardiomyopathy (DCM) and coronary artery disease (CAD) with left ventricular (LV) dysfunction is crucial for appropriate patient management.
- Electrocardiographic (ECG) findings can offer insights into underlying cardiac pathology, but specific differentiating markers between DCM and CAD with LV dysfunction require elucidation.
Purpose of the Study:
- To identify and compare distinct electrocardiographic (ECG) characteristics between patients with DCM and those with CAD and LV dysfunction.
- To determine the diagnostic utility of specific ECG parameters in differentiating these two common cardiac conditions.
Main Methods:
- Analysis of 12-lead electrocardiograms (ECGs) from three groups: 23 patients with DCM, 36 patients with CAD and LV dysfunction, and 63 healthy controls.
- Quantitative assessment of ECG parameters including Q wave presence, R wave voltage in specific leads (RV6), and voltage ratios (RV6/Rmax).
Main Results:
- Abnormal Q waves were more prevalent in CAD (69%) than DCM (26%).
- Higher RV6 voltage and RV6/Rmax ratios were significantly associated with DCM (P < .001). A ratio of 3 or more was found in 61% of DCM patients versus none in CAD or controls.
- The RV6/Rmax ratio correlated with LV dilatation and inversely with ejection fraction in DCM patients.
Conclusions:
- Specific ECG voltage ratios, particularly RV6/Rmax, demonstrate high sensitivity and specificity in differentiating DCM from CAD with LV dysfunction.
- These ECG markers can aid in non-invasively distinguishing between these conditions, potentially guiding further diagnostic and therapeutic strategies.
Abstract:
To elucidate electrocardiographic differences of dilated cardiomyopathy (DCM) and coronary artery disease (CAD) with left ventricular (LV) dysfunction, 12-lead electrocardiograms in 23 patients with DCM, 36 patients with CAD and LV dysfunction, and 63 normal subjects were analyzed. Abnormal Q waves were seen in 69% of CAD patients and in 26% of DCM patients. Abnormal Q waves in leads II, III, aVF, or V2-V4 were present in 61% of CAD patients compared with 4% of DCM patients (P < .001). The R wave in lead RV6 voltage in DCM was the highest among the three groups and correlated with the degree of LV dilatation. RV6 voltage in CAD was the lowest and decreased in proportion to the severity of the apical thallium-201 defect RV6 voltage of 15 mm or more was present in 78% of DCM patients compared with 11% of CAD patients (P < .001). The R waves in leads I, II, and III (RI, RII, RIII) were also low in DCM. Therefore, all voltage ratios of RV6/RI, RII, RIII were the highest in DCM. In particular, the ratio of RV6 over the maximum R wave in leads I, II, and III (RV6/Rmax) in DCM correlated with the degree of LV dilatation and inversely with ejection fraction. RV6/Rmax was significantly higher in the DCM group compared with the CAD and control groups (3.3 vs 1.2, 1.2, respectively; P < .001). This ratio of 3 or more was present in 61% of the DCM patients but in none of the CAD patients or normal subjects (P < .001).(ABSTRACT TRUNCATED AT 250 WORDS)