Echocardiographic recognition of cardiomyopathies
- Nelson B Schiller, MD
Nelson B Schiller, MD
- Section Editor — Noninvasive Cardiac Imaging and Stress Testing
- Professor of Medicine and Anesthesia
- University of California, San Francisco
- Xiushui Ren, MD
Xiushui Ren, MD
- Associate Research Director, Cardiology Fellowship
- California Pacific Medical Center
- Bryan Ristow, MD, FACC, FASE, FACP
Bryan Ristow, MD, FACC, FASE, FACP
- Associate Clinical Professor of Medicine
- University of California, San Francisco
Cardiomyopathy is defined as a disease of heart muscle. Cardiomyopathies include a variety of myocardial disorders that manifest with various structural and functional phenotypes with familial and nonfamilial types. This topic will review the echocardiographic features of the various types of cardiomyopathy. The general evaluation of the patient with heart failure or cardiomyopathy is discussed separately. (See "Determining the etiology and severity of heart failure or cardiomyopathy".)
The classification of cardiomyopathies is reviewed separately. In summary, morphological and functional attributes have been described by the 2006 American Heart Association and 2008 European Society of Cardiology classification systems (table 1A-B) [1,2]. Heart disease secondary to coronary artery, valvular, or congenital heart disease is excluded from the cardiomyopathy classification. However, in clinical practice, the terms “ischemic,” “valvular,” and “hypertensive cardiomyopathy” have been used commonly. There are five types of cardiomyopathy that are each recognized by echocardiography [1,2]. In the MOGE(S) classification endorsed by the World Heart Federation, cardiomyopathy is categorized by the following characteristics: morphofunctional (M), organ involvement (O), genetic or familial inheritance (G), etiological annotation (E), and stage (S) . (See "Definition and classification of the cardiomyopathies".)
●Dilated cardiomyopathy arising as primary myocardial disease of unknown etiology or as disorders of toxic, familial, or infective origin. In clinical practice, ischemic cardiomyopathy is frequently viewed as a type of dilated cardiomyopathy, although current major society classification systems exclude it [1,2]. (See "Causes of dilated cardiomyopathy" and "Familial dilated cardiomyopathy: Prevalence, diagnosis and treatment".)
●Hypertrophic cardiomyopathy, including various causes of increased left ventricular wall thickness not caused by hypertension or valve disease. (See "Hypertrophic cardiomyopathy: Clinical manifestations, diagnosis, and evaluation".) Restrictive cardiomyopathy, including cardiac amyloidosis and endomyocardial fibrosis. (See "Idiopathic restrictive cardiomyopathy" and "Clinical manifestations and diagnosis of amyloid cardiomyopathy" and "Endomyocardial fibrosis".)
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- DILATED CARDIOMYOPATHY
- Echocardiographic findings
- Left ventricular volume
- End-systolic volume index
- Right ventricle
- Left atrium
- Doppler echocardiography
- Cardiac synchrony
- Features of specific types of dilated cardiomyopathy
- - Ischemic cardiomyopathy
- - Chagasic cardiomyopathy
- HYPERTROPHIC CARDIOMYOPATHY
- Echocardiographic features
- - Strain echocardiography
- - Provocative maneuvers
- Differential diagnosis
- - Echocardiographic features of secondary left ventricular hypertrophy
- - Sigmoid septum
- RESTRICTIVE CARDIOMYOPATHY
- Diabetes mellitus
- Amyloid cardiomyopathy
- Endomyocardial fibrosis
- ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY
- UNCLASSIFIED CARDIOMYOPATHY
- SUMMARY AND RECOMMENDATIONS