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2014 CLASSIFICATION Source

  • Arbustini E, Narula N, Tavazzi L, et al. The MOGE(S) classification of cardiomyopathy for clinicians. J Am Coll Cardiol. 2014;64:304–318.

  • This classification of cardiomyopathies takes genetic testing into account.

  • Many cardiomyopathies are familial diseases, and you will be scanning family members with questions about echo.

  • MOGE(S):

    • - Morphofunctional phenotype.

    • - Organ involvement.

    • - Genetic inheritance pattern

    • - Etiology including genetic defect, or underlying disease.

    • - Functional Status.

DILATED CARDIOMYOPATHIES

  • Echo is the primary imaging modality to establish presence and severity of dilated cardiomyopathy.

  • Once the diagnosis is established, echo continues to be a valuable resource that helps to guide treatment and helps to estimate prognosis.

  • Left ventricular chamber size is increased by definition in dilated cardiomyopathy (Fig. 15-1).

  • Left ventricular stroke volume is decreased.

  • Doppler evaluation: It is possible to use Doppler VTI measurements to serially follow changes in LV stroke volume.

  • Technique: Left ventricular outflow tract (LVOT) area multiplied by VTI equals stroke volume. The LVOT area is assumed to remain unchanged from study to study.

  • Therefore, Doppler VTI measurements alone can represent changes in LV stroke volume.

  • Two-dimensional and three-dimensional echo techniques are used to determine end-diastolic and end-systolic left ventricular volumes. This is then used to calculate left ventricular ejection fraction.

  • Another useful measure of global systolic left ventricular function is dP/dt. It calculates the time that it takes the left ventricle to generate 32 mm Hg. The shorter the time, the better the function.

  • Global longitudinal strain is increasingly being used as a quantitative measure of left ventricular function in cancer patients undergoing certain chemotherapy regimens.

  • Ischemic versus nonischemic etiology:

    • - It is useful to know whether a dilated cardiomyopathy is ischemic or nonischemic. Hence, an inquiry about prior cardiac catheterization is always warranted.

    • - With an ischemic cardiomyopathy, the presence of certain regional left ventricular wall motion abnormalities may help decide when to repeat a coronary angiogram.

    • - Patients with nonischemic cardiomyopathy may have regional wall motion abnormalities on echo without underlying coronary artery disease.

    • - The preserved wall motion in nonischemic cardiomyopathy may be confined to the inferior and/or lateral walls.

    • - By knowing that the etiology is nonischemic, the existing wall motion abnormalities are not used improperly for decisions related to coronary artery disease.

FIGURE 15-1

Increased mitral E point to septal separation in dilated cardiomyopathy.

Source

  • Dennis AT, Castro JM. Echocardiographic differences between preeclampsia and peripartum cardiomyopathy. Int J Obstet Anesth. 2014;23:260–266.

An illustration of the key role of echocardiography in cardiomyopathies: Transthoracic echo enables differentiation of heart failure with preserved ejection fraction, commonly observed in women with preeclampsia, from that with peripartum cardiomyopathy, in which a reduced ejection fraction is more common.

  • Sphericity:

    • - The combination of decreased systolic ejection fraction ...

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