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Thallium-201 myocardial imaging in patients with dilated and ischaemic cardiomyopathy.

SUMMARY Ischaemic cardiomyopathy and dilated cardiomyopathy may be clinically indistinguishable and cardiac catheterisation is often required to differentiate between them. We have described the thallium-201 scintigraphic appearances both on exercise and after redistribution in 13 patients with ischaemic cardiomyopathy and 11 patients with dilated cardiomyopathy and have assessed the usefulness of this non-invasive technique in distinguishing between the two groups. All patients with ischaemic cardiomyopathy and seven of the 11 patients with dilated cardiomyopathy displayed perfusion defects. Reversible defects were equally common in the two groups, occurring in approximately 60% of patients. Reverse redistribution defects were confined to the group with ischaemic cardiomyopathy and were found in five patients, and fixed defects were also much more common in this group, being present in 92% compared with 27% of patients with dilated cardiomyopathy. In addition, fixed defects were much more extensive in the group with ischaemic cardiomyopathy and involved greater than 40% of the outer perimeter of the left ventricular image in 10 out of 12 of these patients compared with only one patient in the group with dilated cardiomyopathy. We conclude that the finding of a reversible defect on thallium imaging is non-specific as to aetiology, and does not necessarily imply ischaemic heart disease. The presence, however, of either a fixed defect involving more than 40% of the outer left ventricular perimeter or a reverse redistribution defect strongly favours an ischaemic rather than a dilated cardiomyopathy. Both dilated cardiomyopathy and ischaemic heart disease may have identical clinical presentation with cardiomegaly, impaired left ventricular function, and congestive heart failure.' 2 Subjects cardiomyopathy