Use of ECG and ECHO for differentiation of cardiomegaly induced by idiopathic dilated cardiomyopathy and ischemic cardiomyopathy

ABSTRACT

The clinical, electrocardiographic and echocardiographic findings including pulse Doppler-derived left ventricular filling parameters were utilised in the differential diagnosis of idiopathic dilated cardiomyopathy [IDCM]-induced heart failure and/or cardiomegaly from that produced by ischaemic cardiomyopathy in 152 consecutive patients admitted to a district hospital. Of this total, 91 patients with chronically dilated cardiomyopathy were also analysed separately. Patients with IDCM-induced heart failure were relatively younger, had more symptoms and signs of congestive cardiac failure [CCF], had lower mean arterial pressure [MAP] and higher cardiothoracic ratio [CTR]. Heart failure was the dominant presentation in IDCM in comparison to chest pain in ICM patients. Characteristic infarction [recent/old] ECG pattern was more common among ICM patients in comparison to poor progression of R-wave in IDCM patients. Echocardiographically, IDCM patients were having more global cardiac dilation, generalised hypokinetic wall motions, multiple as well as right sided valvular regurgitation and had significantly lower global left ventricular systolic functions. Restrictive left ventricular diastolic dysfunction pattern was also more common among IDCM. In a hospital setting where invasive cardiac facilities were not available or difficult to arrange in a tertiary hospital or whether cost-effectiveness is concerned, distinction of the two diseases is possible whenever the clinical, electrocardiographic and echocardiographic parameters including the L V filling patterns were combined and utilised. In advanced stages, perhaps, the management might not be altered, though the diagnosis should be reached by non-invasive means; however, the exact diagnosis might not be reached without invasive procedures