Role of Cardiac Imaging: Echocardiography

Excerpt

Echocardiography has crucial importance in the diagnosis of dilated cardiomyopathy (DCM). Echocardiographic features of DCM are left ventricular (LV) dilation and systolic dysfunction with impaired global contractility and normal LV wall thickness and LV diastolic dysfunction with elevation in LV filling pressure. Other frequent characteristics are LV dyssynchrony, right ventricular (RV) dysfunction, atrial dilation, functional mitral and tricuspid regurgitation, and secondary pulmonary hypertension. New echocardiographic technologies can be helpful, i.e., three-dimensional (3D) echocardiography for more accurate assessment of LV volumes and ejection fraction (EF) and speckle tracking for analysis of strain particularly for early diagnosis. Of note, many echocardiographic parameters have demonstrated important prognostic value in DCM.

Echocardiography is also useful in the differential diagnosis of other causes of LV dysfunction in patients with heart failure, as systemic hypertension; coronary, valvular, or congenital heart disease; supraventricular arrhythmias; myocarditis; alcohol abuse; systemic diseases; and cardiotoxicity secondary to antitumoral therapy.

Echocardiography plays also a pivotal role in the management and follow-up of patients with DCM. In fact, echocardiographic reassessment during follow-up under tailored medical therapy has not only important prognostic value but also helps the clinician in optimizing pharmacological treatment and confirming the indication for invasive procedures.

Finally, echocardiography is useful in familial screening for early diagnosis of DCM in asymptomatic patients.