Comments on: Dilated Cardiomyopathy with Mural Thrombus and Classification of Cardiomyopathy

By: Shree

Shree — Thu, 10 Feb 2011 07:55:34 +0000

wants to know it! Thanks!

By: Admin

Admin — Tue, 03 Feb 2009 19:29:53 +0000

There are several M-mode findings that provide diagnostic information in patients with systolic dysfunction. The first of these is the E-point to septal separation (EPSS) defined as the distance (in millimeters) from the anterior septal endocardium to the maximal early opening point (E-point) of the mitral valve.
Because the internal dimension of the left ventricle is proportional to diastolic left ventricular volume and the maximal excursion of the mitral valve in diastole is proportional to the mitral stroke volume, the ratio of the two dimensions will
be proportional to the ejection fraction.
As such, limited mitral valve opening (manifested by a greater distance between the E-point and the septum) is an indirect indicator of a reduced ejection fraction. The normal EPSS is 6 mm, with progressively larger EPPS representing a lower ejection fraction

By: Admin

Admin — Tue, 03 Feb 2009 19:27:56 +0000

Additionally, the left ventricular cavity volume can be determined from several methods (the Simpson rule is the most often used) from which the stroke volume and ejection fraction can be calculated.
Other parameters of systolic function can be derived from Doppler echocardiography.
Of all the different modalities, those that have the most diagnostic and prognostic relevance include end-diastolic and systolic volumes and ejection fraction

By: Admin

Admin — Tue, 03 Feb 2009 19:26:24 +0000

Once the diagnosis has been established, it is clinically useful to quantify the degree of systolic dysfunction. Parameters that have diagnostic and prognostic importance include any of the linear- or area-based measurements of left ventricular size from which the derived parameters of fractional shortening and fractional area change can be calculated.

By: Admin

Admin — Tue, 03 Feb 2009 19:23:59 +0000

The echocardiographic features of dilated cardiomyopathy parallel the primary and secondary findings were stated above. Left ventricular dilation is ubiquitous and a requisite component for establishing the diagnosis.
The degree of dilation can be mild or substantial with left ventricular internal dimensions of as large as 8.0 cm occasionally being encountered. The distribution of systolic dysfunction within the left ventricular walls is dependent on whether the cardiomyopathy has an ischemic etiology.
Classically, if an ischemic etiology is present, there will be greater regional variation in systolic dysfunction than if the process is nonischemic. It should be emphasized, however, that in documented nonischemic cardiomyopathy, there will be regional variation in the degree of systolic dysfunction, typically with the proximal portions of the inferoposterior and posterior lateral walls having preserved function when compared with other left ventricular segments.
As a consequence of dilation and systolic dysfunction, the left ventricle takes on a more spherical geometry that further contributes to the deterioration of left ventricular systolic function because the spherical geometry interferes with the contractile efficiency of the myocardial fibers.
Normally, the long axis dimension of the left ventricle exceeds the minor axis dimension (diameter) with a ratio of 1.6:1 or greater. With progressive dilation, the minor axis increases disproportionally, and the ratio of long to minor axis decreases.
Typically, a ratio (sphericity index) of less than 1.5:1 implies marked pathologic remodeling. The increasing spherical geometry results in apical and lateral displacement of the papillary muscles.
This has the result of effectively reducing the length of the mitral apparatus as compared with the anulus and results in secondary functional mitral regurgitation