REGIONAL WALL-MOTION ANALYSIS BY DOBUTAMINE STRESS ECHOCARDIOGRAPHY TO DISTINGUISH BETWEEN ISCHEMIC AND NONISCHEMIC DILATED CARDIOMYOPATHY

To distinguish between ischemic and nonischemic dilated cardiomyopathy (DCM), we studied 43 patients with left ventricular dysfunction (15 i schemic and 28 nonischemic detected by coronary angiography) by dobuta mine stress echocardiography. At rest, there were more normal segments (p<0.001) and a trend toward more akinetic segments (p, not significa nt) per ischemic than per nonischemic DCM patient. However, either at rest or with low-dose dobutamine, individual data largely overlapped. At peak dose, in ischemic DCM, regional contraction worsened in many n ormal or dyssynergic regions at rest (in the latter case after improve ment with low-dose dobutamine); in contrast, in nonischemic DCM, furth er mild improvement was observed in a variable number of left ventricu lar areas. Thus with peak-dose dobutamine, more akinetic and less norm al segments were present per ischemic than per nonischemic DCM patient (both, p<0.001). A value of six or more akinetic segments was 80% sen sitive and 96% specific for ischemic DCM. Our data show that analysis of regional contraction by dobutamine stress echocardiography can dist inguish between ischemic and nonischemic DCM.