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Assessment of ventricular coupling with real-time cine MRI and its value to differentiate constrictive pericarditis from restrictive cardiomyopathy

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Abstract

The purpose of this study was to evaluate the use of respiratory-related ventricular coupling to differentiate patients with constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM). In 18 histologically proven cases of CP, 6 patients with inflammatory pericarditis (IP), 15 RCM patients and 17 normal subjects, real-time cine MRI was performed in the cardiac short-axis (basal half of the ventricles) during operator-guided deep respiration. The images were analyzed for ventricular septal position and shape during early ventricular filling. Early diastolic septal inversion (I) or flattening (F) was found in all CP (I:15,F:3), and in all IP (I:2,F:4), but seldom in normals (F:1) and not in RCM. The septal abnormalities occurred at the onset of inspiration and rapidly disappeared with the next heartbeats. The amount of ventricular coupling was evaluated by quantifying the difference in the maximal septal excursion between inspiration and expiration. This parameter, normalized to the biventricular diameter, was significantly larger in CP (20.0±4.5%, P<0.0001) and IP (14.8±3.2%, P<0.0001) patients than in normals (7.0±2.4%), whereas RCM patients had a trend toward decreased excursion (4.2±1.7%, P=0.11). A cut-off value of 11.8% (mean normals +2 SD) enabled to differentiate CP patients from normals and RCM patients completely. Real-time cine MRI can easily depict increased ventricular coupling, which may be helpful to better differentiate between CP and RCM patients, especially in patients with normal or minimally thickened pericardium. The increase in coupling in IP patients is likely caused by decreased compliance of the inflamed pericardial layers.

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References

  1. Spodick DH (1997) The Pericardium: a Comprehensive Textbook. M. Dekker, New York, NY, 233,464

    Google Scholar 

  2. Sechtem U, Tscholakoff D, Higgins CB (1986) MRI of the abnormal pericardium. Am J Roentgenol 47:245–252

    Google Scholar 

  3. Talreja DR, Edwards WD, Danielson GK et al (2003) Constrictive pericarditis in 26 patients with histologically normal pericardial thickness. Circulation 108:1852–1857

    PubMed  Google Scholar 

  4. Hatle LK, Appleton CP, Popp RL (1989) Differentiation of constrictive pericarditis and restrictive cardiomyopathy by Doppler echocardiography. Circulation 79:357–370

    CAS  PubMed  Google Scholar 

  5. Hancock EW (2001) Differential diagnosis of restrictive cardiomyopathy and constrictive pericarditis. Heart 86:343–349

    CAS  PubMed  ADS  Google Scholar 

  6. Giorgi B, Mollet NR, Dymarkowski S, Rademakers F, Bogaert J (2003) Assessment of ventricular septal motion in patients clinically suspected of constrictive pericarditis, using magnetic resonance imaging. Radiology 228:417–424

    PubMed  Google Scholar 

  7. Francone M, Dymarkowski S, Kalantzi M, Bogaert J (2005) Real-time cine MRI of ventricular septal motion. A novel approach to assess ventricular coupling. J Magn Reson Imaging 234:542–547

    Google Scholar 

  8. Guzman PA, Maugham WL, Yin FCP et al (1981) Transseptal pressure gradient with leftward septal displacement during the Mueller manoeuvre in man. Br Heart J 46:657–662

    CAS  PubMed  Google Scholar 

  9. Santamore WP, Bartlett R, Van Buren SJ, Dowd MK, Kutcher MA (1986) Ventricular coupling in constrictive pericarditis. Circulation 74:597–602

    CAS  PubMed  Google Scholar 

  10. Haley JH, Tajik AJ, Danielson GK, Schaff HV, Mulvagh SL, Oh JK (2004) Transient constrictive pericarditis: causes and natural history. J Am Coll Cardiol 43:271–275

    PubMed  Google Scholar 

  11. Hasuda T, Satoh T, Yamada N et al (1999) A case of constrictive pericarditis with local thickening of the pericardium without manifest ventricular interdependence. Cardiology 92:214–216

    CAS  PubMed  Google Scholar 

  12. Rienmüller R, Gürgan M, Erdman E, Kemkes BM, Kreutzer E, Weinhold C (1993) CT and MR evalution of pericardial constriction: a new diagnostic and therapeutic concept. J Thorac Imaging 8:108–121

    Article  Google Scholar 

  13. Masui T, Finck S, Higgins CB (1992) Constrictive pericarditis and restrictive cardiomyopathy: evaluation with MR imaging. Radiology 182:369–373

    CAS  PubMed  Google Scholar 

  14. Bogaert J, Dymarkowski S, Taylor AM (2005) Pericardial Disease in Clinical Cardiac MRI. Springer, Berlin Heidelberg New York, 294–300

    Google Scholar 

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Authors and Affiliations

  1. Department of Radiology and Cardiology, Gasthuisberg University Hospital, Herestraat 49, 3000, Leuven, Germany

    Marco Francone, Steven Dymarkowski, Maria Kalantzi, Frank E. Rademakers & Jan Bogaert

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  1. Marco Francone
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  2. Steven Dymarkowski
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  3. Maria Kalantzi
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  4. Frank E. Rademakers
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  5. Jan Bogaert
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Corresponding author

Correspondence to Jan Bogaert.

Additional information

M. Francone and M. Kalantzi were supported by the European Commission with a Marie-Curie Fellowship.

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Francone, M., Dymarkowski, S., Kalantzi, M. et al. Assessment of ventricular coupling with real-time cine MRI and its value to differentiate constrictive pericarditis from restrictive cardiomyopathy. Eur Radiol 16, 944–951 (2006). https://doi.org/10.1007/s00330-005-0009-0

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  • DOI: https://doi.org/10.1007/s00330-005-0009-0

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