Decreased systolic and diastolic mitral annular velocities, restrictive pattern in mitral valve such as high velocity (E wave), short deceleration time and low late diastolic filling (A wave), and elevated filling pressures (E/e ratio) are seen [12,80]. Before the widespread use of harmonic imaging, the myocardium was described as having a characteristic speckled (starry sky) appearance [64], a finding now considered obsolete with the widespread use of harmonic imaging techniques. A relative apical sparing of longitudinal strain of 1.0 (average apical longitudinal strain/average of basal and mid longitudinal strain) has a high sensitivity (93%) and specificity (82%) in distinguishing cardiac amyloidosis from controls [81]. Apical thickening may be seen in endomyocardial fibrosis. In sarcoidosis, echocardiography shows ventricular septal thickening and diastolic dysfunction in the acute phase but thinning in the chronic phase with associated RWMA, aneurysm, and global systolic dysfunction [55]. Echocardiography Transthoracic Stress There is no relevant literature to support the use of echocardiography transthoracic stress for the evaluation of restrictive cardiomyopathy. Ischemia has already been excluded. Variant 3: Suspected nonischemic dilated and unclassified cardiomyopathy. Ischemic cardiomyopathy already excluded. Initial imaging. DCM is characterized by a dilated ventricle and global systolic dysfunction. Ischemia is the most common cause of DCM and is excluded as discussed above. Approximately 50% of nonischemic DCM is idiopathic and is usually seen in a younger age group [2]. Other etiologies include toxins, familial inheritance, infections, infiltrative disorders, autoimmune conditions, metabolic derangements, and arrhythmias. Alcoholic cardiomyopathy is seen in heavy drinkers with probable genetic susceptibility, more common in men 30 to 55 years of age [2,82].
Nonischemic Myocardial Disease with Clinical Manifestations Ischemic Cardiomyopathy Already Excluded . Decreased systolic and diastolic mitral annular velocities, restrictive pattern in mitral valve such as high velocity (E wave), short deceleration time and low late diastolic filling (A wave), and elevated filling pressures (E/e ratio) are seen [12,80]. Before the widespread use of harmonic imaging, the myocardium was described as having a characteristic speckled (starry sky) appearance [64], a finding now considered obsolete with the widespread use of harmonic imaging techniques. A relative apical sparing of longitudinal strain of 1.0 (average apical longitudinal strain/average of basal and mid longitudinal strain) has a high sensitivity (93%) and specificity (82%) in distinguishing cardiac amyloidosis from controls [81]. Apical thickening may be seen in endomyocardial fibrosis. In sarcoidosis, echocardiography shows ventricular septal thickening and diastolic dysfunction in the acute phase but thinning in the chronic phase with associated RWMA, aneurysm, and global systolic dysfunction [55]. Echocardiography Transthoracic Stress There is no relevant literature to support the use of echocardiography transthoracic stress for the evaluation of restrictive cardiomyopathy. Ischemia has already been excluded. Variant 3: Suspected nonischemic dilated and unclassified cardiomyopathy. Ischemic cardiomyopathy already excluded. Initial imaging. DCM is characterized by a dilated ventricle and global systolic dysfunction. Ischemia is the most common cause of DCM and is excluded as discussed above. Approximately 50% of nonischemic DCM is idiopathic and is usually seen in a younger age group [2]. Other etiologies include toxins, familial inheritance, infections, infiltrative disorders, autoimmune conditions, metabolic derangements, and arrhythmias. Alcoholic cardiomyopathy is seen in heavy drinkers with probable genetic susceptibility, more common in men 30 to 55 years of age [2,82].