Abstract
The global left ventricular systolic impairment with left ventricular dilatation can manifest due to idiopathic dilated cardiomyopathy or ischemic heart disease and can present a similar clinical picture of severe heart failure. The aim of our investigation was to assess a differential diagnostic value of resting (99m)Tc-MIBI myocardial perfusion defects in evaluation of the etiology of heart failure. The data of 2D echocardiography, coronary angiography, and myocardial gated single photon emission computed tomography with (99m)Tc-MIBI investigation were evaluated in 43 patients with global left ventricular systolic impairment, characterized by left ventricular end-diastolic diameter of > or =65 mm and ejection fraction of < or =40%. The idiopathic dilative cardiomyopathy was diagnosed in 26 patients (Group 1) and ischemic heart failure in 17 patients (Group 2). The area and the degree (severity) of myocardial perfusion defects (AMPD and DMPD) at rest in regions supplied by three coronary arteries were evaluated in all the patients. The area of perfusion defects in the left anterior descending (LAD) and right coronary artery (RCA) regions in dilative cardiomyopathy patients was smaller than in ischemic heart failure patients (1.43+/-0.9 vs 2.53+/-0.53, P=0.001, and 2.19+/-0.6 vs 2.82+/-0.56, P=0.02). The degree of perfusion defects was also less severe in the same circulation regions (1.39+/-0.93 vs 2.59+/-0.6, P=0.01, and 1.6+/-0.46 vs 2.71+/-0.15, P=0.001). We have designed a logistic regression model expressed by formula x=2.52AMPD(rca)+2.47AMPD(lad)+2.21DMPD(rca). Idiopathic dilative cardiomyopathy was predicted when x was < or =16 and ischemic heart failure when x was >16. The sensitivity in predicting idiopathic dilative cardiomyopathy was 94.44%, and the specificity was 88.24%. The difference in the area and degree of (99m)Tc-MIBI myocardial perfusion defects at rest in patients with heart failure caused by idiopathic dilative cardiomyopathy or ischemic heart failure is measurable and has a predictive value for differentiation of the etiology of global left ventricular systolic impairment.
Highlights
We have designed a logistic regression model expressed by formula x=2.52AMPDrca+2.47AMPDlad+2.21DMPDrca
According to the contemporary definition and classification of the cardiomyopathies suggested by the American Heart Association (AHA) scientific statement, idiopathic dilated cardiomyopathy (IDCM) is characterized by systolic dysfunction and dilatation of the left ventricular (LV) chamber, which lead to progressive heart failure (HF) with subsequent complications [1]
According to the position statement of the working group on myocardial and pericardial diseases of the European Society of Cardiology [2], IDCM could be defined in the presence of LV dilatation and LV systolic dysfunction and in the absence of ischemic heart disease (IHD), hypertensive heart disease, and Correspondence to E
Summary
According to the contemporary definition and classification of the cardiomyopathies suggested by the American Heart Association (AHA) scientific statement, idiopathic dilated cardiomyopathy (IDCM) is characterized by systolic dysfunction and dilatation of the left ventricular (LV) chamber, which lead to progressive heart failure (HF) with subsequent complications [1]. According to the position statement of the working group on myocardial and pericardial diseases of the European Society of Cardiology [2], IDCM could be defined in the presence of LV dilatation and LV systolic dysfunction and in the absence of ischemic heart disease (IHD), hypertensive heart disease, and. A precise differential diagnosis allows better selection of optimal conservative or surgical treatment, as well as prognostication of outcomes and selection of preventive measures of disease progression
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