SHOULD PATIENTS BE SUBMITTED TO CORONARY ARTERIOGRAPHY AFTER ECHOCARDIOGRAPHIC DIAGNOSIS OF IDIOPATHIC DILATED CARDIOMYOPATHY

Objectives: The present study was designed to determine if patients wi th an echocardiographic diagnosis of idiopathic dilated cardiomyopathy should be submitted to coronary arteriography. Background: Whether ec hocardiography allows distinction of idiopathic dilated cardiomyopathy from severe coronary heart disease remains controversial. Methods: A questionnaire was sent out to the members of the Swiss Society of Card iology. In the first study 78 patients with an echocardiographic diagn osis of idiopathic dilated cardiomyopathy who had undergone coronary a rteriography or had been followed-up for > 5 years were investigated. In a second study, the echocardiograms of 50 patients with either idio pathic cardiomyopathy or severe coronary heart disease, all of whom ha d also undergone coronary arteriography, were reviewed by two independ ent echocardiographers without access to any, complementary informatio n. Result: The questionnaire revealed that one half of the Swiss cardi ologists generally refer such patients for coronary arteriography. The first study showed that the diagnosis of idiopathic dilated cardiomyo pathy was confirmed in, all cases, in which the echocardiographer had been certain of the diagnosis (64/78 [82%]). In the uncertain cases (1 4 [18%]) coronary arteriography revealed 9 idiopathic cardiomyopathies , 3 coronary heart diseases, and 2 mixed etiologies. The second study showed that a correct diagnosis was achieved in 85% of cases. Furtherm ore, the echocardiographers were able to specify those patients with a n uncertain diagnosis who would therefore require coronary arteriograp hy. Conclusions: In the overwhelming majority of cases, echocardiograp hy can distinguish idiopathic dilated cardiomyopathy from severe coron ary heart disease. Coronary arteriography is only indicated when. the echocardiographer is uncertain of the diagnosis. The routine and costl y practice of coronary arteriography of these patients does not appear to be justified.