FREQUENCY OF ECHOCARDIOGRAPHIC COMPLICATIONS OF DILATED CARDIOMYOPATHY AT A TERTIARY CARE HOSPITAL
AbstractBackground: Dilated cardiomyopathy can lead to a variety of complications recognisable onclinical, echocardiographic, electrocardiographic and radiographic assessment. Among this,transthoracic echocardiography has the dual advantage of being helpful in making the diagnosis ofdilated cardiomyopathy as well as an effective tool in early recognition of certain complicationsfor timely management to improve the quality of life of these patients. Methods: This descriptive(case series) study was undertaken at Departments of Medicine, Cardiology, Paediatrics andObs/Gyn, Ayub Teaching Hospital, Abbottabad from July to December, 2008. Fifty patients ofdilated cardiomyopathy without age and gender discrimination were selected by conveniencesampling. Those with hypertrophic and restrictive cardiomyopathies, valvular and congenital heartdisease, hypertension and ischemic heart disease were excluded. Results: Mean age was47.12±17.9 year with male predominance (males=34, females=16). Mean ejection fraction was30.6±6.9%. Complications revealed on echocardiography were intracardiac thrombi (5, 10%),spontaneous echo contrast (5, 10%), pericardial effusion (6, 12%), mitral regurgitation (46, 92%),tricuspid (25, 50%), aortic (5, 10%), pulmonary (2, 4%) multi-valvular regurgitation (28, 56%),and left atrial dilatation (36, 72%). Conclusion: LV systolic dysfunction, cardiac thrombi,spontaneous echo contrast, mitral and tricuspid regurgitation and left atrial enlargement areimportant complications of dilated cardiomyopathy. Echocardiography is important tool towardsidentification of these complications.Keywords: cardiomyopathy, dilated, cardiomyopathy, complications, cardiomyopathy,congestive, echocardiography
Wynne J, Braunwald E. Cardiomyopathy and myocarditis. In:
Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL,
Jameson JL. (eds) Harrison’s Principles of Internal Medicine: 16th
ed. New York: The McGraw-Hill; 2005.p.1408–14.
Lavoie HM, Preston C. Cardiomyopathy, Dilated. [On line] 2005
July 7 last Up-date. [Cited 2006 December 15]: Available from:
Ahmad R, Awan ZA. An echocardiographic study of 129 cases of
cardiomyopathy. J Coll Physicians Surg Pak 1999;9:171–3.
Khan MA, Mohammad J, Hussain M. Frequency and
echocardiographic study of dilated cardiomyopathy in children
presenting with cardiac failure. Pak J Med Sci 2004;20:113–6.
Kadish A, Dyer A, Daubert JP, Quigg R, Anderson KP, Calkins
H, et al. Prophylactic defibrillator implantation in patients with
non-ischemic dilated cardiomyopathy. N Engl J Med
Sadiq M, Rathore AW, Younis M, Haider N, Masud F, Rehman
A. Thromboembolism in patients with myocarditis. Ann K E
Med Coll 2005;11:50–3.
Ahmad R, Awan ZA. A case series study of 26 subjects with left
ventricular thrombus to see its etiology and left ventricular
function. Pak J Med Sci 2004;20:51–4.
Ahmad R, Awan ZA. Atrial clots and their correlation with
various denominators: A study of 26 cases. Pak J Med Sci
Mas JL, Arquizan C, Lanny C, Zuber M, Cabanes L, Derumeaux
G, et al. Recurrent cerebrovascular events associated with patent
foramen ovale, atrial septal aneurysm or both. N Engl J Med
J Ayub Med Coll Abbottabad 2011;23(3)
Pengo V, Lensing AWA, Prins MH, Marchiori A, Davidson BL,
Tiozzo F, et al. Incidence of chronic thrombo-embolic pulmonary
hypertension after pulmonary embolism. N Engl J Med
Taylor MR, Carniel E, Mestroni L. Cardiomyopathy, familial
dilated. Orphanet J Rare Dis 2006;1:27–35.
Bashore TM, Granger CB. Heart. In: Tierney LM, McPhee SJ,
Papadakis MA. Current Medical Diagnosis & Treatment 45th ed.
California: McGraw-Hill: 2006:p. 400–2.
Dec G.W, Fuster V. Idiopathic dilated cardiomyopathy. N Engl J
Napporn AG, Kane A, Damorou JM, Dia AA, Diop IB, Sarr M, et
al. Intraventricular thrombosis complicating peri-partum
idiopathic myocardiopathy. Ann Cardiol Angeiol (Paris)
Mc Crindle BW, Karamlou T, Wong H, Gangam N, Trivedi KR,
Lee KJ, et al. Presentation, management and outcomes of
thrombosis for children with cardiomyopathy. Can J Cardiol
Kumar H. Incidence of intracavitary thrombus in dilated
cardiomyopathy. J Assoc Physicians India 1994;42:753–4.
Mazzone M, La Sala M, Portale G, Ursella S, Forte P, Carbone L,
et al. Review of dilated cardiomyopathies: Dilated
cardiomyopathies and altered prothrombotic state: a point of view
of the literature. Panminvera Med 2005;47:157–67.
Falk RH, Foster E, Coats MH. Ventricular thrombi and
thromboembolism in dilated cardiomyopathy: a prospective
follow-up study. Am Heart J 1992;123:136–42.
Blondheim DS, Jacobs LE, Kotler MN, Costacurta GA, Parry
WR. Dilated cardiomyopathy with mitral regurgitation: decreased
survival despite a low frequency of left ventricular thrombus. Am
Heart J 1991;122:763–71.
Siostrzonek P, Koppensteiner R, Gossinger H, Zangeneh M,
Heinz G, Kreiner G, et al. Hemodynamic and hemorheologic
determinants of left atrial spontaneous echo contrast and thrombus
formation in patients with idiopathic dilated cardiomyopathy. Am
Heart J 1993;125:430–4.
Tramarin R, Torbicki A, Franchini M, Forni G, Febo O, Gibellini
R, et al. Transoesophageal echocardiography in the definition of
intracardiac sources of emboli in patients with recent ischemic
stroke. G Ital Cardiol 1990;20:713–9.
Dall’Aglio V, Nicolosi GL, Zanuttini D. Transthoracic and
transoesophageal echocardiographic documentation of
disappearance of massive right atrial and pulmonary artery
thromboemboli after fibrinolytic therapy and normalization of left
ventricular dimensions and function. Eur Heart J 1990;11:863–5.
Shen WF, Tribouilloy C, Rida Z, Peltier M, Choguet D, Rey JL,
et al. Clinical significance of intracavitary spontaneous echo
contrast in patients with dilated cardiomyopathy. Cardiology
Afridi HR, Hartnell GG. Cardiomyopathy, dilated. [On line] 2005
February 10 last up-date. [Cited 2008 December 15]: Available
from: URL: http://www.emedicine.com/
Touze JE, Mouanodji G, Mardelle T, Akani F, Ekra A, Bertrand
E. Primary congestive cardiomyopathies of the adult in a tropical
environment: nosologic, diagnostic and developmental data. Med
Trop (Mars) 1987;47:95–9.
Luthra A. (editor) Echo made easy. 1st ed. New-Dehli: Jaypee
Brothers Medical Publishers; 2005.p.77–83.
Venturi F, Gianfaldoni ML, Melina G, Cecchi A, Petix NR,
Monopoli A, et al. Mitral effective regurgitant orifice area versus
left ventricular ejection fraction as prognostic indicators in patients
with dilated cardiomyopathy and heart failure. Ital Heart J
Diaz RA, Nihoyannopoulos P, Oakley CM. Valvular insufficiency
in dilated cardiomyopathy diagnosed by color Doppler
echocardiography. Rev Med Chil 1989;117:1232–5.