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Clin. Cardiol. 23, 417-420 (2000)

Comparison of Echocardiography and Electron Beam Tomography in Differentiating the Etiology of Heart Failure

Thuy Le, M.D., John Y. Ko, B.S., H. Tina Kim, M.D., Pamela Akinwale, B.S., Matthew J. Budoff, M.D.

The Department of Medicine, Division of Cardiology, Harbor-UCLA Research and Education Institute, Torrance, California, USA

Summary

Background: The clinical manifestations in patients with ischemic cardiomyopathy are often indistinguishable from those in patients with primary dilated cardiomyopathy (DCM). Clinicians often base work-up of patients with heart failure on echocardiographic wall motion abnormalities; however misclassification can lead to unnecessary coronary angiography.

Hypothesis: The study was undertaken to evaluate the diagnostic ability of echocardiography and electron beam tomography (EBT) to differentiate between ischemic and nonischemic cardiomyopathy.

Methods: The accuracy of EBT and echocardiography was compared in 111 patients undergoing coronary angiography for the evaluation of heart failure. The presence of coronary calcification (CC) by EBT or segmental wall motion abnormalities by echocardiography was used as evidence of coronary-induced cardiomyopathy.

Results: Of 63 patients, 61 (97%) with obstructive coronary artery disease had CC by EBT. This sensitivity was significantly higher compared with 43 of 63 patients (68%) with segmental wall motion abnormalities by echocardiography (p<0.001). Of 48 patients without obstructive coronary artery disease by angiography, 39 (81%) had no CC by EBT and 35 (73%) had no segmental wall motion (global hypokinesis) by echocardiography (p = 0.33). The overall accuracy of EBT to differentiate ischemic from nonischemic cardiomyopathy was 90%, significantly higher than echocardiography (70%, p<0.001).

Conclusion: This double-blind study demonstrates that the presence of CC by EBT is superior to that of segmental wall motion abnormalities by echocardiography to distinguish ischemic from nonischemic cardiomyopathy. This modality may prove to be an important diagnostic tool when the etiology of the cardiomyopathy is not clinically evident.

Key words: electron beam tomography, echocardiography, cardiomyopathy, heart failure, etiology

Address for reprints:
Matthew J. Budoff, M.D., F.A.C.C.
Saint John's Cardiovascular Research Center
1124 West Carson Street, RB-2
Torrance, CA 90502, USA

Received: May 24, 1999
Accepted with revision: August 12, 1999

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