What is the role of echocardiogram in monitoring cardiomyopathy (disease of the heart muscle)?

From the Guidelines

Echocardiograms are recommended every 1-2 years for routine monitoring of stable cardiomyopathy, with more frequent testing (every 3-6 months) for patients with progressive disease or recent changes in clinical status, as supported by the European Association of Cardiovascular Imaging 1.

Key Points for Echocardiogram Monitoring

• The initial comprehensive echocardiogram establishes baseline cardiac function, measuring left ventricular ejection fraction, chamber dimensions, wall thickness, and valvular function.
• For hypertrophic cardiomyopathy, annual screening is typically sufficient, while dilated cardiomyopathy may require more vigilant monitoring, especially with symptoms like increasing shortness of breath or edema.
• Echocardiograms help guide medication adjustments for heart failure therapies such as beta-blockers, ACE inhibitors, ARBs, and SGLT2 inhibitors.
• They also identify complications requiring intervention, including worsening systolic function, valve regurgitation, or thrombus formation.

Importance of Global Longitudinal Strain (GLS)

• GLS of sub-endocardial fibres should be assessed in all patients with heart failure, especially when left ventricular ejection fraction is preserved, as it provides valuable information on ventricular function 1.
• Values < –16% indicate mild depression of GLS and values < –10% are consistent with a severe reduction of GLS.

Individualized Monitoring Approach

• The frequency of echocardiogram monitoring should be individualized based on disease severity, stability, medication changes, and the presence of implanted devices like pacemakers or defibrillators.
• This non-invasive imaging modality provides crucial information about disease progression and treatment effectiveness without radiation exposure, making it ideal for long-term monitoring of cardiomyopathy patients.

Additional Imaging Modalities

• Cardiac magnetic resonance (CMR) is an important tool to consider in every patient with dilated cardiomyopathy, as it provides tissue characterization and may suggest the cause of ventricular dysfunction 1.
• Cardiac-computed tomography (CT) is highly valuable for excluding significant epicardial coronary artery disease and for guiding device implantation.

From the Research

Echocardiogram for Cardiomyopathy Monitoring

• Echocardiography is essential for the diagnosis and prognosis of cardiomyopathies, including dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), restrictive cardiomyopathy (RCM), and arrhythmogenic right ventricle cardiomyopathies (ARVC) 2.
• The most characteristic features of these cardiomyopathies can be identified using echocardiography, such as asymmetric left ventricular hypertrophy and systolic anterior motion of the mitral valve with the obstructive phenotype in HCM, and dilated left ventricle with different degrees of systolic dysfunction in DCM 2, 3.
• Echocardiography plays a crucial role in the assessment of patients with HCM, including diagnosis, screening, management formulation, prognosis, and follow-up, and helps to differentiate HCM from other diseases 3.
• Recent advancements in echocardiographic techniques, such as strain imaging, speckle-tracking, and 3D echocardiography, have improved diagnostic accuracy and provided important prognostic value in the assessment of cardiomyopathies 4.
• Multimodality imaging, including resting and stress imaging, provides comprehensive and complementary information to help clarify the mechanisms responsible for symptoms in patients with HCM, and guides treatment options such as septal reduction therapy and mitral valve repair 5.

Role of Echocardiography in Cardiomyopathy Monitoring

• Echocardiography is a non-invasive imaging modality that provides crucial information on cardiac structure, function, and hemodynamics, making it an essential tool for monitoring cardiomyopathies 2, 4.
• Echocardiographic parameters are involved in risk score computing and prognosis assessment, and can help identify patients at high risk of sudden cardiac death 2, 5.
• The integration of different echocardiographic modalities can provide a comprehensive assessment of cardiomyopathies, supported by updated knowledge of the latest guidelines and recently published articles 3.
• Artificial intelligence integration can improve diagnostic accuracy and workflow efficiency in echocardiography, refining diagnostic capabilities and providing prognostic insights 4.