Heart Muscle Diseases (Cardiomyopathies): Diagnostic Tests

Mandatory medical device diagnostics.

Dilated (dilated) cardiomyopathy (DCM)

  • Echocardiography (echo; cardiac ultrasound) to examine/detect:
    • Primary dilatation (widening) of the left, and later both, ventricles (heart chambers)
    • Decreased amplitude of motion of the ventricular wall with restriction of inward systolic motion
    • Evidence of spontaneous echocontrast (advanced stage).
    • Detection of manifest thrombi (blood clots) in the ventricle or atrium (advanced stage).
  • Magnetic resonance imaging of the thorax/chest (thoracic MRI) – anatomy or function of the heart and heart valves.
  • X-ray of the thorax (X-ray thorax/chest), in two planes – because of cardiomegaly (enlargement of the myocardium (heart muscle)) and pulmonary congestion (water in the lungs) and to detect fibrosis (pathological (pathological) increase of connective tissue).

Hypertrophic (enlarged) cardiomyopathy (HCM)

  • Echocardiography (echo; cardiac ultrasound).
    • Asymmetric septal hypertrophy or hypertrophy of the entire myocardium of the left ventricle with constriction of the left ventricular outflow tract (LVOT)
  • Electrocardiogram (ECG; recording of the electrical activity of the heart muscle) – to check the functioning of the electrical leads:
    • Left hypertrophy sign
    • Pseudoinfarct images with deep Q-spikes and negative T left precordial (due to septal hypertrophy)
    • Possible left anterior hemiblock (25%).
    • Ventricular arrhythmias, possibly QT time prolongation (40%).
  • Possibly left heart catheterization (coronary angiography* ), if the findings from echocardiography are not sufficient; to exclude that one of the coronary vessels (coronary arteries) is stenosed (narrowed).
  • Magnetic resonance imaging of the thorax/chest (thoracic MRI) to examine/detect:
    • Anatomy or function of the heart
    • Pressure gradient
    • Fibrosis detection, correlating to the maximum expression of wall thickening.

* Radiological procedure that uses contrast agents to visualize the lumen (interior) of the coronary arteries (arteries that surround the heart in a wreath shape and supply blood to the heart muscle).

Restrictive (limited) cardiomyopathy (RCM)

  • Echocardiography (echo; cardiac ultrasound) with Doppler; for examination/detection of:
    • Enlarged heart cavities: enlarged atria with normal-sized ventricles.
    • Systolic contraction is largely normal
  • Computed tomography of the thorax/chest (thoracic CT).
  • Magnetic resonance imaging of the thorax/chest (thoracic MRI).
  • X-ray of the thorax (X-ray thorax/chest), in two planes.

Arrhythmogenic right ventricular cardiomyopathy (ARVCM)

  • Echocardiography (echo; cardiac ultrasound).
    • Search for local or global motion abnormalities of the right ventricle (RV).
    • RV dilatation
    • Caveat: A normal finding does not exclude the disease.
    • In later stages, the left ventricle (LV) may also be involved.
  • Electrocardiogram (ECG; recording of the electrical activity of the heart muscle).
    • Detection of an epsilon wave at the end of the widened QRS complex (V1-3; in 10% of cases); in the signal-averaging ECG, this corresponds to a late potential
    • Quotient of QRS widths (V1-3/V4-6) ≥ 1.2
    • T-negative – possibly
    • Right bundle branch block – possible
  • Magnetic resonance imaging of the thorax/chest (chest MRI).
    • Right ventricular fatty deposits.
    • Detection of aneurysms (dilations of the vessel wall).
  • Possibly right ventricular angiography (visualization of blood vessels by contrast medium in an X-ray examination).
    • Search for local motion abnormalities as well as hypokinesia of the RV (decreased motion of the right ventricle).

Athlete’s heart notes: sport-induced intermittent pressure and volume loading can lead to dilatation of all four ventricles; left ventricular hypertrophy occurs. Endurance athletes may develop right ventricular dysplasia (right ventricles often dilated but near normal right ventricular ejection fraction).ECG: right bundle branch block or T negatives over the anterior wall.

Isolated (ventricular) noncompaction cardiomyopathy (NCCM)

  • Echocardiography (echo; cardiac ultrasound).
    • Echocriteria according to Jenni and Stöllberg:
      • Evidence of at least four prominent trabeculae (tubercle-like tissue structures) and recessus (cavity, bulge).
      • Evidence of blood flow between the ventricular cavity (cavity of the heart) and the recesses.
      • Typical bilayered structure of the affected left ventricular myocardium (myocardium of the left ventricle).
      • Systolic ratio of noncompact subendocardial layer to compact subepicardial layer > 2.
  • Magnetic resonance imaging of the thorax/chest (thoracic MRI) – alternatively, if echodiagnosis is insufficient.