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Dilated Cardiomyopathy

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Book cover The ESC Textbook of Cardiovascular Imaging

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Abstract

Dilated cardiomyopathies, either familial-genetic or non-familial-genetic, in origin are characterized by dilatation of one or both ventricles and/or ventricular systolic dysfunction. The modern imaging techniques allow assessing the primary myocardial defect in force generation as well as abnormalities in the metabolic, perfusion, and structural patterns. The diagnostic and the prognostic role of the three most used techniques (echocardiography, nuclear technologies, and cardiac magnetic resonance, CMR) are discussed with the purpose of integrating the specific information that can be achieved by each of them.

According to a recent statement of the European Society of Cardiology, dilated cardiomyopathy (DCM) is defined by the presence of left ventricular dilatation and left ventricular systolic dysfunction in the absence of abnormal loading conditions (hypertension, valve disease) or coronary artery disease (CAD) sufficient to cause global systolic impairment. Right ventricular dilation and dysfunction may be present, but are not necessary for the diagnosis.1

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Author information

Authors and Affiliations

  1. MRI Laboratory, Clinical Physiology Institute, CNR National Research Council, Via Moruzzi, Pisa, 56010, Italy

    Massimo Lombardi

Authors
  1. Massimo Lombardi
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  2. Danilo Neglia
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  3. Petros Nihoyannopoulos
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  4. Albert C. van Rossum
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Corresponding author

Correspondence to Massimo Lombardi .

Editor information

Editors and Affiliations

  1. Hospital Clinico San Carlos, Instituto Cardiovascular, C/Professor Martin Lagos, s/n, 28040, Madrid, Spain

    José Luis Zamorano

  2. Medical Center Dept. Cardiology, Leiden University, Albinusdreef 2, 2333, Leiden, ZA, Netherlands

    Jeroen J. Bax

  3. Dept. Cardiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Frank E. Rademakers

  4. Turku PET Centre, Turku University Hospital, FI-20521, Turku, Finland

    Juhani Knuuti

Appendices

Video 24.1

Apical 4-chamber view from a patient who presented with an out of hospital cardiac arrest. The LV is not dilated with full-thickness myocardium and marked global hypokinesia. Contrast-enhanced CMR did not show any myocardial scar

Video 24.2

Real-time 3D echocardiographic images from a patient with dilated cardiomyopathy. With some simple identification of endocardial borders, the system calculates the left ventricular volumes automatically

Video 24.3

Report of a PET perfusion study (13NH3 as a flow tracer) combined with a CT coronary angiography study performed at IFC-CNR and FGM in Pisa. The study was done in a male patient, 60 years old, with cardiovascular risk factors, recent onset of LBBB and moderate LV dysfunction (LVEF 33% at 2D-Echo) for differential diagnosis between ischaemic or primitive dilated cardiomyopathy. The video clip shows a fusion image of volumetric reconstruction of perfusion PET data obtained during dipyridamole stress and of reconstructed CT angiography data in the diastolic phase of the cardiac cycle. A clear and wide perfusion defect is evident involving the lateral-inferior wall of the left ventricle in the presence of angiographycally normal epicardial coronary vessels. A similar flow defect was also evident in resting conditions. Absolute myocardial blood flow was severely reduced in all myocardial regions both at rest (range 0.35–0.51 mL/min/g, Normal Values >0.6 mL/min/g) and during dipyridamole stress (range 0.52–0.72 mL/min/g) with reduced myocardial perfusion reserve (range 1.38–1.52, normal values >2.5). The diagnosis of primitive dilated cardiomyopathy associated with coronary micro-vascular dysfunction was confirmed at invasive catheterization

Video 24.4

Acute myocarditis. Cine images (SSFP) in 4-chamber view demonstrating slightly dilated LV with EF 47%

Video 24.5

Chagas’ disease. Cine images/SSFP) on 2-chamber view. The LV is dilated with manifestation of several small aneurysms and a large apical aneurysm with trans-mural hyper-enhancement due to fibrosis

Video 24.6

Patient with non-compaction cardiomyopathy (cine images- SSFP - short axis) demonstrating meshwork of trabeculae predominantly in the apex. The end-diastolic non-compacted to compacted ratio exceeds 2.3

Video 24.7

Patient with non-compaction cardiomyopathy (cine images - SSFP - vertical long axis) demonstrating meshwork of ­trabeculae predominantly in the apex. The end-diastolic noncompacted to compacted ratio exceeds 2.3

Video 24.8

Myocardial crypts in the proximal infero-septal wall as observed in genetically proven carrier of hypertrophic cardiomyopathy mutation (cine images -SSFP - modified 2-chamber view)

Video 24.9

Myocardial crypts in the proximal infero-septal wall as observed in genetically proven carrier of hypertrophic cardiomyopathy mutation (cine images - SSFP - short axis view)

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Lombardi, M., Neglia, D., Nihoyannopoulos, P., van Rossum, A.C. (2010). Dilated Cardiomyopathy. In: Zamorano, J.L., Bax, J.J., Rademakers, F.E., Knuuti, J. (eds) The ESC Textbook of Cardiovascular Imaging. Springer, London. https://doi.org/10.1007/978-1-84882-421-8_24

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  • DOI: https://doi.org/10.1007/978-1-84882-421-8_24

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-420-1

  • Online ISBN: 978-1-84882-421-8

  • eBook Packages: MedicineMedicine (R0)

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