Objective?To study the echocardiographic features of ischemic cardiomyopathy and dilated cardiomyopathy, to analyze the differential diagnosis value of echocardiography and provide the basis for early diagnosis of the disease. Methods?The clinical data of 110 patients admitted to Xi'an 630 Hospital from August 2013 to November 2020 who underwent coronary angiography due to cardiac insufficiency and cardiac dilatation indicated by ultrasound were retrospectively analyzed, according to the diagnosis results, they were divided into the ischemic cardiomyopathy group (60 cases) and the dilated cardiomyopathy group (50 cases). All patients underwent echocardiography, and the cardiac ultrasound measurement indexes and cardiomyopathy valve regurgitation of the two groups were compared. Results?The proportion of patients with round and thin left ventricular apex, left ventricular round arch, and segmental weakening of the ventricular wall in the ischemic cardiomyopathy group were significantly higher than those in the dilated cardiomyopathy group; the proportion of patients with spherical left ventricle and diffuse weakening of the ventricular wall were significantly lower than those in the dilated cardiomyopathy group; the left atrial diameter (LA), left ventricular end-diastolic diameter (LVEDD), left ventricular end-diastolic volume (EDV), and left ventricular end-systolic volume (ESV), right ventricular end-diastolic diameter (RVEDD) levels of the ischemic cardiomyopathy group were significantly lower than those in the dilated cardiomyopathy group, left ventricular ejection fraction (LVEF), peak mitral valve velocity in late diastole (PVA), aortic valve peak systolic velocity (AV) and pulmonary valve peak systolic velocity (PV) were significantly higher than those in the dilated cardiomyopathygroup (all P<0.05); the total incidence of aortic regurgitation (AR) in the ischemic cardiomyopathy group was higher than that in the dilated cardiomyopathy group, but the difference was not statistically significant (P>0.05); the total incidences of mitral regurgitation (MR) and tricuspid regurgitation (TR) in the ischemic cardiomyopathy group were significantly lower than those in the dilated cardiomyopathy group (all P<0.05). Conclusion?Patients with ischemic cardiomyopathy and patients with dilated cardiomyopathy have significantly different cardiac structures on echocardiographic images. Patients with dilated cardiomyopathy have larger cardiac chamber diameters and a higher incidence of TR than patients with ischemic cardiomyopathy. The two diseases can be differentially diagnosed according to the above characteristics to reduce the probability of clinical misdiagnosis.