Utility value of tissue doppler imaging during dobutamine stress in differentiating ischemic from nonischemic dilated cardiomyopathy.

Arumugam, C (2007) Utility value of tissue doppler imaging during dobutamine stress in differentiating ischemic from nonischemic dilated cardiomyopathy. Masters thesis, Madras Medical College, Chennai.

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Abstract

Differentiating ischemic from nonischemic cardiomyopathy poses a particular problem, but this is important prognostically and therapeutically. Patients with ischemic cardiomyopathy have worse prognosis than the patients with idiopathic dilated cardiomyopathy. Joseph et al, in 1983 have demonstrated that in patients with severe chronic left ventricular failure, mortality rate in patients with coronary artery was 46% and 69% at 1 and 2 years, respectively compared with 23% and 48% at 1 and 2 years in those with idiopathic dilated cardiomyopathy. In 1997, Bradley and colleagues also have shown ischemic etiology is a significant independent predictor of mortality in patients with cardiomyopahy. Therapeutically also it is important to distinguish between ischemic and nonischemic cardiomyopathy because the diagnosis influences the management. Antiplatelets and lipid lowering therapy are important in management of patients with cardiomyopathy of ischemic etiology. Revascularisation in patients with low ejection fraction and significant coronary artery disease is strongly associated with improved survival and should be considered in all patients with ischemic cardiomyopathy and proven hibernation. Moreover ischemic cardiomyopathy may not respond to medical therapy as favorably as patients with nonischemic cardiomyopathy. Differentiating ischemic from nonischemic cardiomyopathy clinically is not always easy. Although ischemic cardiomyopthy is generally a late consequence of clinically established coronary artery disease, sometimes the clinical course is really occult and indistinguishable from idiopathic cardiomyopathy. An ischemic cause is probable in patients with history of definite or documented prior myocardial infarction or left ventricular aneurysm in echocardiogram. However, some patients with ischemic cardiomyopathy have neither history nor electrocardiographic evidence of myocardial infarction, never complaint of chest pain and shows diffuse rather than regional hypocontractility. Conversely many patients with idiopathic dilated cardiomyopathy report frequent episodes of chestpain and have electrocardiographic evidence of myocardial infarction. CONCLUSIONS : (1) Tissue Doppler Imaging during dobutamine stress is a simple, and effective non-invasive modality in differentiating ischemic from nonischemic dilated cardiomyopathy. (2) Blunted response to dobutamine identifies ischemic cardiomyopathy. (3) Tissue Doppler Imaging was especially useful in patients with left bundle branch block and dilated cardiomyopathy. (4) Tissue Doppler Imaging findings correlate well with coronary angiogram.

Item Type: Thesis (Masters)
Uncontrolled Keywords: tissue doppler imaging ; dobutamine stress ; ischemic ; nonischemic ; dilated ; cardiomyopathy.
Subjects: MEDICAL > Cardiology
Depositing User: Kambaraman B
Date Deposited: 04 Jul 2017 03:48
Last Modified: 04 Jul 2017 03:48
URI: http://repository-tnmgrmu.ac.in/id/eprint/862

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