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Differentiation of Ischemic and Dilated Cardiomyopathy on Electrocardiograms

Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran

For reprint information contact: Amir Aslani, MD, Tel: 98 711 843 3095, Fax: 98 711 227 7182, Email: aslanidr{at}yahoo.com, Namazee Hospital, PO Box 71935 1334, Shiraz, Iran.

Differentiating coronary artery disease with left ventricular dysfunction from dilated cardiomyopathy is important prognostically and therapeutically. To provide a diagnostic algorithm to distinguish these conditions using a standard 12-lead electrocardiogram, all 105 patients with left ventricular ejection fraction < 50% who underwent angiography between January 2004 and December 2006 were studied prospectively. Coronary artery disease was defined as 50% stenosis of the left main coronary artery or 70% stenosis of 1 or more of the 3 major epicardial arteries. Normal coronary angiography findings with left ventricular ejection fraction < 50% was defined as dilated cardiomyopathy. The most specific finding for differentiation of these diseases was pathologic Q waves in lead II, aVF, V3 or V4. The most sensitive parameter was a ratio 5 of R-wave amplitudes in lead V6 and lead III (94% sensitive). The 12-lead electrocardiogram provides a useful noninvasive method for differentiation of dilated cardiomyopathy from coronary artery disease with left ventricular systolic dysfunction.