DK2985_C000 1..28 - AlSharqia Echo Club

Cardiomyopathy 229volumes are both increased. They are typically .50 mm insystole and .70 mm in diastole. As stated previously, it isrecommended that the dimension of the LV be measuredusing M-mode in the transgastric short-axis view at thelevel of the papillary muscles (Fig. 10.15). The ventricularvolumes can be estimated with the Simpson’s method ofdisks, but this technique applied to TEE often underestimatesthe true volume because of foreshortening of theapex. Ventricular mass is also increased, principally becauseof enlarged LV, with variable increase in wall thickness,developing in order to reduce wall stress. This findingseems to identify patients with a better prognosis (23).Right ventricular involvement is variable and usuallyparallels left ventricular dilatation. Its involvement secondaryto pulmonary hypertension or tricuspid regurgitation(TR) can also be found. Occasionally, the RV isspared by disease, in which case an ischemic etiologyshould be suspected. Right and left atrial dilatation iscommon as a result of chronically elevated filling pressureand/or atrial fibrillation.2. Ventricular Systolic DysfunctionReduced contractility is the hallmark of DCM. Evaluationof global and segmental wall motion should be done usingmultiple windows; the transgastric short-axis views at 08are particularly useful for this purpose (Fig. 10.15). Thedecrease in systolic function is typically diffuse, butregional wall motion abnormalities can be present,suggesting an underlying ischemic etiology. However,this finding is neither sensitive nor specific for coronaryartery disease (CAD), as regional wall motion abnormalitieshave been described in DCM in the absence of coronarylesion.Many techniques have been described to quantify systolicfunction (Chapter 5): “E” point–septal separation(Fig. 10.16), volumetric-based measurements, Dopplerderivedstroke volume quantification, dP/dt evaluation,myocardial performance index calculation, or simpleglobal visual estimation. All these methods reflect, to avariable extent, the depressed systolic function. The(A)(B)RVLV(C)Figure 10.15 (A, B) Transgastric mid-papillary view in a 56-year-old woman with dilated ischemic cardiomyopathy. (C) M-modemeasurements show akinesis of the inferior wall and hypokinesis of the anterior wall. The left ventricular end-diastolic diameter(arrow) is 7.1 cm (Normal ,5.5 cm) (LV, left ventricle; RV, right ventricle).