Retrospective and prospective studies of high resolution cross sectional echocardiograms were undertaken in order to establish an ultrasonic method for the non-invasive estimation of degeneration and fibrosis of the endomyocardium in cases of cardiomyopathy. When the echocardiograms of the ventricular wall were compared with the histological specimens intense abnormal echoes were seen at the sites of myocardial degeneration and fibrosis of the ventricular wall. The abnormal echoes classified into five types: types I, II, III-1, III-2, and III-3. Type I and type III-1 echoes were the strongest followed by those of types II and III-2, and then those of type III-3. The intensity of the abnormal echoes was 5-20 decibels stronger than that from intact tissue and was closely related to the consistency and density of the diseased tissue. These findings strongly suggest that the boundary between degeneration or fibrosis and the intact normal myocardium was the source of the abnormal myocardial echoes and that the extent and the pattern of the distribution of the sites of degeneration and fibrosis in the myocardium were reflected in the echo patterns. Thus the tissue characteristics of the sites of degeneration or fibrosis of the myocardium may be determined non-invasively by measuring the echo intensity.
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