Usefulness of cardiac calcification on two-dimensional echocardiography for distinguishing ischaemic from nonischaemic dilated cardiomyopathy: a preliminary report.

BACKGROUND: Aortic valve calcification (AVC) and/or mitral annulus calcification (MAC) is considered to be a marker of atherosclerosis and has been demonstrated to predict cardiovascular morbidity and mortality. AIM: We hypothesized that the presence of cardiac calcification by echocardiography can be used in the differential diagnosis between ischaemic (DCMI+) and nonischaemic dilated cardiomyopathy (DCMI-). METHODS: We evaluated 62 patients with DCM (38 males, mean age 66 +/- 10 years, LVEF or = 70% stenosis of at least one coronary artery was found. AVC, MAC, aortic wall and papillary muscle calcifications were semiquantitatively assessed by two-dimensional echocardiographic examination with a calcium score ranging from 0 (no calcifications) to 8 (calcium in all four sites). RESULTS: DCMI+ was found in 20 out of 62 patients. As expected, there were no differences in LVEF and LV end-diastolic diameters between DCMI+ and DCMI--patients (29 +/- 8% versus 31 +/- 10% and 66 +/- 6 versus 68 +/- 8 mm, respectively; not significant). Regional wall motion abnormalities and conventional risk factors for atherosclerosis, such as hypertension and hypercholesterolaemia, were significantly more frequent in the DCMI+ compared to the DCMI- group. On the other hand, the calcium echo score was 4.6 +/- 2 (range 1.7-7.3) in DCMI+ patients and 0.8 +/- 0.95 (range 0-4) in DCMI--patients (P or = 3 was observed in 18 out of 20 (90%) DCMI+ patients and only in three of 42 (8%) DCMI--patients. CONCLUSIONS: The assessment of cardiac calcification by two-dimensional echocardiography could represent a simple, noninvasive and inexpensive approach to assess the aetiology (ischaemic versus nonischaemic) of dilated cardiomyopathy.