[Differential diagnosis of congestive cardiomyopathy and myocardial ischemia: two-dimensional echocardiography has a limited value].

Two dimensional echocardiographic studies were performed in 70 patients with chronic heart failure. Thirty six had dilated cardiomyopathy and normal coronary arteries and 34 had ischemic cardiomyopathy with severe multivessel coronary disease. All patients had a dilated and hypocontractile left ventricle. Ejection fraction assessed by radionuclide ventriculography was less than 40% in all patients. Regional wall motion abnormalities were detected in 16 (44%) of 36 patients with dilated cardiomyopathy and 22 (65%) of 34 patients with ischemic cardiomyopathy (NS). High echodensity of the regional wall motion abnormality suggesting a myocardial scar were found in 4 (25%) of 16 patients with dilated cardiomyopathy and in 9 (41%) of 22 with ischemic cardiomyopathy (NS). Diffuse wall motion abnormalities were present in 20 (56%) patients with dilated cardiomyopathy and 12 (35%) with ischemic cardiomyopathy (NS). Right ventricular dilatation was found in 21 (58%) and 20 (59%) patients with dilated and ischemic cardiomyopathy, respectively (NS). No differences between groups were found regarding the left ventricular size and function. In conclusion, two dimensional echocardiography cannot be reliably used in patients with chronic heart failure to differentiate dilated cardiomyopathy from ischemic cardiomyopathy.