This is a 47-years old lady who presented with mild breathlessness. Among other tests, an echocardiogram showed diffuse hypokinesia with an ejection fraction of approximately 30%. There was no prior history of cardiac disease or any clinical evidence of coronary artery disease and dilated cardiomyopathy was suspected.
Dilated cardiomyopathy can be diagnosed on cardiac MRI, when there is no delayed hyperenhancement or only areas of mid-myocardial enhancement in a patient with diffuse hypokinesia in all segments. Though this is an intuitive way of evaluating this problem, the general trend has been to perform a coronary angiogram - if the angiogram is normal, it suggests dilated cardiomyopathy - if the angiogram is abnormal, it is likely that the patient has ischemic cardiomyopathy or cardiomyopathy due to coronary artery disease.
In such situations, a cardiac CT seems to be a viable alternative to catheter coronary angiography, especially when the pre-test probabality of coronary artery disease is low. In this patient, the cardiac CT was normal (Figs. 1-4 - RCA & branches - black arrow, LAD - blue arrow, CX & branches - green arrow). The cine file shows the diffuse hypokinesia of all segments in the mid-cavitary and apical regions - the ejection fraction was 21%.
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