Electrocardiographic and echocardiographic features that distinguish anomalous origin of the left coronary artery from pulmonary artery from idiopathic dilated cardiomyopathy

Many authors have reported noninvasive means of diagnosing anomalous left c oronary artery from pulmonary artery (ALCAPA) and differentiating ALCAPA fr om idiopathic dilated cardiomyopathy (DCM). Systematic evaluation using the se noninvasive diagnostic modalities is not available. To distinguish betwe en ALCAPA and DCM using a systematic approach, we examined 23 patients with ALCAPA (age 1 month to 23 years, median 7 months) and 23 patients with DCM (age 5 days to 16 years, median 6.6 months). Standard 12-lead electrocardi ograms (ECG) and 2-dimensional (2-D) and color Doppler echocardiograms were performed. A logistic regression model was applied using ALCAPA diagnosis as the dependent variable and ECG and echocardiographic findings as indepen dent variables. A scoring system was created to establish the ALCAPA diagno sis based on results from the logistic regression. On the logistic regressi on, the ECG feature of QT pattern in aVL (Q wave greater than or equal to 3 mm deep with an inverted T wave) and echocardiographic features of right c oronary artery diameter to aortic annulus ratio greater than or equal to 0. 14, increased papillary muscle echogenicity, and Doppler color flow of LCA from aorta or pulmonary artery were the most significant differentiating fe atures between the ALCAPA and DCM groups. A scoring system was developed us ing the previous five variables and assigning a score of 1 to each variable (-1 to Doppler color flow of LCA from aorta). The scoring system had sensi tivity of 100% and specificity of 91% for ALCAPA diagnosis. Compared with p revious reported diagnostic features in differentiating ALCAPA and DCM, the scoring system had a much higher specificity and positive predictive value . In conclusion, we selected the most useful ECG and echo-cardiographic fea tures to differentiate between ALCAPA and DCM and created a scoring system to aid clinical diagnosis. This scoring system may be useful in evaluating children with acute congestive heart failure.