Echocardiography Transthoracic Resting Echocardiography can evaluate the function in several types of nonischemic DCM. It does not provide tissue characterization to identify the specific cause of cardiomyopathy, but the presence of systolic dysfunction in patients on chemotherapy, postpartum, and alcoholic patients is suggestive of cardiomyopathy. In chemotherapy, a reduction of EF by >10% or a reduction of EF >5% in symptomatic individuals is diagnostic of this entity (as long as the resultant EF is <53%). Calculation of LVEF by 3-D echocardiography is more reproducible and accurate than by 2-D echocardiography and is preferred for the evaluation and longitudinal assessment of patients treated with chemotherapy [100]. A 10% to 15% reduction of peak systolic global longitudinal strain by speckle-tracking echocardiography is the most useful parameter to predict cardiotoxicity [119]. Global radial and circumferential strains are abnormal in late survivors, but their clinical value is less proven [119]. Decreased global longitudinal strain with preserved EF is the most common echocardiographic abnormality in cancer survivors [100]. Echocardiography can confirm, quantify, and detect associated abnormalities and complications, as well as risk stratify patients [120]. In LV noncompaction, echocardiography shows a 2-layered structure with prominent LV trabeculations (end- systolic ratio >2) and deep perfused intertrabecular recesses in color Doppler [86,121]. The sensitivity and reproducibility of echocardiography is improved by using LV contrast [122]. LV strain is decreased in noncompacted as well as compacted segments [122]. Transient reversible global systolic dysfunction as well as RWMA (apical, mid ventricular, basal, or focal in anterolateral segment) are seen in stress-induced cardiomyopathy [95].
Nonischemic Myocardial Disease with Clinical Manifestations Ischemic Cardiomyopathy Already Excluded . Echocardiography Transthoracic Resting Echocardiography can evaluate the function in several types of nonischemic DCM. It does not provide tissue characterization to identify the specific cause of cardiomyopathy, but the presence of systolic dysfunction in patients on chemotherapy, postpartum, and alcoholic patients is suggestive of cardiomyopathy. In chemotherapy, a reduction of EF by >10% or a reduction of EF >5% in symptomatic individuals is diagnostic of this entity (as long as the resultant EF is <53%). Calculation of LVEF by 3-D echocardiography is more reproducible and accurate than by 2-D echocardiography and is preferred for the evaluation and longitudinal assessment of patients treated with chemotherapy [100]. A 10% to 15% reduction of peak systolic global longitudinal strain by speckle-tracking echocardiography is the most useful parameter to predict cardiotoxicity [119]. Global radial and circumferential strains are abnormal in late survivors, but their clinical value is less proven [119]. Decreased global longitudinal strain with preserved EF is the most common echocardiographic abnormality in cancer survivors [100]. Echocardiography can confirm, quantify, and detect associated abnormalities and complications, as well as risk stratify patients [120]. In LV noncompaction, echocardiography shows a 2-layered structure with prominent LV trabeculations (end- systolic ratio >2) and deep perfused intertrabecular recesses in color Doppler [86,121]. The sensitivity and reproducibility of echocardiography is improved by using LV contrast [122]. LV strain is decreased in noncompacted as well as compacted segments [122]. Transient reversible global systolic dysfunction as well as RWMA (apical, mid ventricular, basal, or focal in anterolateral segment) are seen in stress-induced cardiomyopathy [95].