[Ultrasonographic assessment of carotid atherosclerosis for the differentiation of ischemic cardiomyopathy and dilated cardiomyopathy].
OBJECTIVE
We assessed the clinical value of carotid intima-media thickness (IMT) for the differentiation of ischemic cardiomyopathy (ICM) and dilated cardiomyopathy (DCM).


METHODS
We studied 38 patients who showed left ventricular dilation and low ejection fraction (< 40%) by cardiac catheterization. There were 15 patients with ICM which was defined as stenosis of > 75% at one major branch or more. Twenty-three patients were found to have DCM as diagnosed by histological examination using biopsy specimens. Carotid IMT visualized by B-mode imaging was measured at 16 sites in the extracranial carotid arteries, and the maximum IMT, mean IMT, and plaque score were calculated. These parameters together with cardiovascular risk factors including age, sex, hypertension, diabetes mellitus, hypercholesterolemia, cigarette smoking, and obesity were compared between the ICM and the DCM groups.


RESULTS
The maximum IMT, mean IMT, and plaque score in the ICM group were 2.80 +/- 1.63 mm, 1.21 +/- 0.36 mm, 13.05 +/- 8.12, respectively, which were significantly higher than the corresponding parameters in the DCM group (1.19 +/- 0.51 mm, 0.73 +/- 0.15 mm, 1.52 +/- 2.51; p < 0.001, respectively). Furthermore, plaque score of greater than 5 was found to be an excellent diagnostic parameter for ICM with 91% sensitivity and 100% specificity. The cardiovascular risk factors did not differ between the two groups.


CONCLUSIONS
Our observations demonstrate that assessment of carotid IMT is a clinically useful tool to differentiate ICM and DCM in patients with left ventricular dysfunction. In particular, coronary angiography should be recommended in patients with a plaque score of greater than 5.
Tamura
Tadashi
T
Division of Cardiology, Jikei University School of Medicine, Nishi-shinbashi 3-25-8, Minato-ku, Tokyo 105 - 8461. tamutamu@jikei.ac.jp
Nojiri
Ayumi
A
Sakamoto
Hiroshi
H
Kurusu
Osamu
O
Mochizuki
Seibu
S
D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis*; D017539:Tunica Intima / Q000473:pathology; D018084:Ultrasonography, Interventional