الفهرس 
CARDIOMYOPATHYOnly 14 pages are availabe for public view
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Abstract
Background: Differentiation between the two main causes of CHF (ischemic and primary cardiomyopathy) is a very important issue. Patients with ischemic cardiomyopathy tend to have a poorer prognosis unless revascularization done, either surgically or interventionally. Several non-invasive techniques have been proposed to establish the etiology of CHF, but the results are controversial. Tissue Doppler imaging is an easy, widely used, objective promising tool for such differentiation.
Aim of the work: To identify the accuracy of pulsed wave tissue Doppler imaging, especially tricuspid annular velocities, as a non-invasive diagnostic tool in the differentiation between primary and ischemic dilated cardiomyopathy.
Patients and methods: According to the results of coronary angiography, we studied 40 patients with ischemic cardiomyopathy (ICM group) and 40 patients with primary dilated cardiomyopathy (DCM group) in addition to 20 healthy volunteers as a control group. All patients were subjected to thorough history taking, clinical examination, 12-lead surface electrocardiogram and most importantly echo-Doppler study with special stress on PW-TDI (pulsed wave tissue Doppler imaging).
Results: In ischemic group there were statistically significant lower peak mitral annular systolic and early diastolic velocities in all studied portions of mitral annulus compared with DCM patients, with no significant difference between both groups regarding peak late diastolic (Aa) velocity. Also, there were significantly higher peak tricuspid annular systolic and late diastolic velocities with lower early diastolic velocity in ischemic group. The ratios of early to late diastolic annular velocities of both mitral and tricuspid valves were significantly lower in ischemic patients.
Conclusion: Absence of RV dysfunction is the main characteristic parameter for ICM as evidenced by preserved tricuspid annular peak systolic velocity with a cut point of ≥ 8.5 cm/sec. which has 88% sensitivity and 93% specificity. Also, the tricuspid to average mitral Sa ratio is another important differentiating measure with a cut point of ≥ 1.2 in ICM group which has 100% sensitivity and 95% specificity.