Comparison of new Doppler echocardiographic methods to differentiate constrictive pericardial heart disease and restrictive cardiomyopathy

doi:10.1016/S0002-9149(00)01278-9

The American Journal of Cardiology

Volume 87, Issue 1, 1 January 2001, Pages 86-94

https://doi.org/10.1016/S0002-9149(00)01278-9 Get rights and content

Abstract

This study assesses how the newer modalities of tissue Doppler echocardiography and color M-mode flow propagation compare with respiratory variation of Doppler flow in distinguishing between constrictive pericarditis and restrictive cardiomyopathy. We studied 30 patients referred for further evaluation of diastolic function who had a diagnosis of constrictive pericarditis or restrictive cardiomyopathy established by diagnostic tests, including clinical assessment, magnetic resonance imaging, cardiac catheterization, endomyocardial biopsy, and surgical findings. Nineteen patients had constrictive pericarditis and 11 had restrictive cardiomyopathy. We performed 2-dimensional transesophageal echocardiography combined with pulsed-wave Doppler of the pulmonary veins and mitral inflow with respiratory monitoring, tissue Doppler echocardiography of the lateral mitral annulus, and color M-mode flow propagation of left ventricular filling. Respiratory variation of the mitral inflow peak early (peak E) velocity of ≥10% predicted constrictive pericarditis with 84% sensitivity and 91% specificity and variation in the pulmonary venous peak diastolic (peak D) flow velocity of ≥18% distinguished constriction with 79% sensitivity and 91% specificity. Using tissue Doppler echocardiography, a peak early velocity of longitudinal expansion (peak E_a) of ≥8.0 cm/s differentiated patients with constriction from restriction with 89% sensitivity and 100% specificity. A slope of ≥100 cm/s for the first aliasing contour in color M-mode flow propagation predicted patients with constriction with 74% sensitivity and 91% specificity. Thus, the newer methods of tissue Doppler echocardiography and color M-mode flow propagation are equivalent and complimentary with Doppler respiratory variation in distinguishing between constrictive pericarditis and restrictive cardiomyopathy. The additive role of the new methods needs to be established in difficult cases of constrictive pericarditis where respiratory variation may be absent or decreased.

Section snippets

Study population

The study population consisted of 30 patients with predominantly right-sided cardiac failure and clinically suspected complex diastolic dysfunction, who were referred to the transesophageal echocardigraphic (TEE) laboratory for determination of constrictive pericarditis or restrictive cardiomyopathy. All patients had a complete evaluation with pulsed-wave Doppler of the pulmonary venous flow and mitral inflow, tissue Doppler echocardiography, and color M-mode Doppler. There were 24 men and 6

Pulmonary venous flow

The pulmonary venous flow data for both groups are described in Table 2. The pulmonary venous peak systolic flow velocity was significantly greater in patients with constrictive pericarditis than in patients with restrictive cardiomyopathy during the inspiration and expiration phases (p <0.001). The increase in the peak systolic flow velocity from inspiration to expiration (percent E) in patients with constricive pericarditis was not significantly different from the respiratory variation in

Discussion

In the last decade, Doppler echocardiography with respiratory monitoring has been used to differentiate constrictive pericarditis from restrictive cardiomyopathy.2, 5 Recently, tissue Doppler echocardiography and color M-mode Doppler have been advanced as newer methods of evaluating diastolic function in these diseases.10, 11 This study is the first to compare all 3 Doppler echocardiographic techniques to differentiate these 2 similar conditions in the same series of patients. Our results show

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Echocardiographic Criteria to Differentiate Constrictive Pericarditis From Restrictive Cardiomyopathy: A Meta-analysis
2023, CJC Open
To assess the diagnostic accuracy of the Mayo Clinic echocardiographic criteria for differentiating between constrictive pericarditis and restrictive cardiomyopathy.
We searched electronic databases for the date range from their inception to July 1, 2022. The index tests were the Mayo Clinic echocardiographic criteria. We performed a bivariate random-effects model to estimate the pooled sensitivity and specificity, each with 95% confidence interval (CI). The area under the curve of the summary receiver operator characteristic curves, with 95% CI, was also calculated.
We included 17 case-control studies involving 889 patients. The pooled sensitivity and specificity (95% CI), respectively, were as follows: ventricular septal shift, 82% (60%-94%) and 78% (65%-87%); respiratory variation in mitral inflow ≥ 14.6%, 71% (51%-85%) and 82% (66%-91%); septal eʹ velocity ≥ 8 cm/s, 83% (80%-87%) and 90% (83%-95%); septal eʹ velocity/lateral eʹ velocity ≥ 0.88, 74% (64%-82%) and 81% (70%-88%); and hepatic vein ratio in expiration ≥ 0.79, 73% (65%-81%) and 71% (19%-96%). The area under the curve of the summary receiver operator characteristic curves varied from 0.75 to 0.85, with overlapping CIs across index tests.
Our meta-analysis suggests that all echocardiographic parameters from the Mayo Clinic criteria have good diagnostic accuracy for differentiating between constrictive pericarditis and restrictive cardiomyopathy.
Évaluation de l’exactitude diagnostique des critères échocardiographiques de la clinique Mayo visant à faire la distinction entre une péricardite constrictive et une cardiomyopathie restrictive.
Nous avons effectué une recherche dans des bases de données électroniques pour la période s’étendant de leur date de création au 1^er juillet 2022. Les tests de concordance portaient sur les critères échocardiographiques de la clinique Mayo. Nous avons réalisé un modèle à effets aléatoires et à deux variables afin d’estimer la sensibilité et la spécificité en fonction des données regroupées, chacune avec un intervalle de confiance (IC) à 95 %. L’aire sous la courbe des courbes caractéristiques sommaires de la performance du test, avec un IC à 95 %, a également été calculée.
Nous avons inclus 17 études cas-témoins comptant 889 patients. Selon les données groupées, la sensibilité et la spécificité (IC à 95 %), respectivement, étaient les suivantes : déplacement du septum interventriculaire, 82 % (60 à 94 %) et 78 % (65 à 87 %); variation respiratoire lors du remplissage mitral ≥ 14,6 %, 71 % (51 à 85 %) et 82 % (66 à 91 %); vitesse eʹ mesurée en septal ≥ 8 cm/s, 83 % (80 à 87 %) et 90 % (83 à 95 %); rapport vitesse eʹ mesurée en septal/vitesse eʹ mesurée en latéral ≥ 0,88, 74 % (64 à 82 %) et 81 % (70 à 88 %); et rapport veineux hépatique lors de l’expiration ≥ 0,79, 73 % (65 à 81 %) et 71 % (19 à 96 %). L’aire sous la courbe des courbes caractéristiques sommaires de la performance du test variait de 0,75 à 0,85, avec des IC se chevauchant dans les tests de concordance.
Notre méta-analyse laisse entendre que tous les paramètres échocardiographiques de la clinique Mayo ont une bonne exactitude diagnostique pour faire la distinction entre la péricardite constrictive et la cardiomyopathie restrictive.
Cardiac surgery for constrictive pericarditis
2022, Debulking in Cardiovascular Interventions and Revascularization Strategies: Between a Rock and the Heart
The pericardium is a protective cardiac biologic tissue. The pericardial structure consists of an avascular, double-walled sac containing two layers: the visceral pericardium, which is a thin layer comprising an inner serous monolayer and pericardial physiologic fluid, and the parietal pericardium, which consists of an outer fibroelastic layer. There are two pericardial sinuses: transverse and oblique. The pericardium serves important ligamentous, membranous, metabolic, reflexive, and mechanical functions that are described within the text of this chapter. Constrictive pericarditis is a serious cardiac pathologic process with profound clinical and hemodynamic implications. In constrictive pericarditis, chronic fibrous tight thickening of the pericardial tissue develops secondary to inflammation. As a result, the pericardial elasticity and compliance are adversely effected, in a process that severely impairs cardiac physiology. Clinically, constrictive pericarditis commonly presents with a picture of right-sided heart failure including symptoms of fatigue, exertional dyspnea, and peripheral edema. Associated left cardiac chambers dysfunction also presents as pulmonary congestive symptoms, chest pain, palpitations, abdominal symptoms, and frank anasarca. The unique physical examination findings when this pathology is encountered are delineated in this chapter. The diagnosis of constrictive pericarditis involves physical examination, electrocardiography, chest radiography, and echocardiography. Further evaluation and confirmation include cardiac imaging with computed tomography, magnetic resonance, and, when indicated, right and left heart catheterization.
Definitive surgical management is commonly performed through pericardiectomy. This operation remains technically challenging and its various approaches, challenges, and complications are described. Long-term survival after pericardiectomy is largely dependent on etiology and on patient comorbidities such as older age, New York Heart Association (NYHA) class, renal dysfunction, pulmonary hypertension, increased Child-Pugh liver disease, previous chest irradiation, and hyponatremia. Postoperatively, most patients exhibit improved hemodynamic condition, improved cardiac function, and become symptom free providing that accurate pre-op assessment, adequate patient selection, and timely surgical intervention are performed.
Color M-mode Doppler
2020, Diastology: Clinical Approach to Heart Failure with Preserved Ejection Fraction
Early diastolic flow propagation velocity (Vp) obtained by color M-mode Doppler is an index of left ventricular (LV) relaxation that is relatively independent of loading conditions. In normal conditions Vp is greater than 45 m/sec. Vp is related to diastolic ventricular suction. Vp is slow in conditions that affect ventricular relaxation such as in restrictive cardiomyopathy and LV systolic dysfunction. A ratio of mitral inflow E wave to Vp has been correlated to left atrial pressure.
Primary Restrictive, Infiltrative, and Storage Cardiomyopathies
2020, Diastology: Clinical Approach to Heart Failure with Preserved Ejection Fraction
Idiopathic cardiomyopathies are divided into three forms: primary restrictive, infiltrative, and storage disorders. Primary restrictive cardiomyopathies are usually genetically inherited. They are characterized by bi-atrial enlargement with non-dilated ventricles in addition to a characteristic histopathological morphology. Cardiac transplantation is the ideal treatment. Cardiac amyloidosis is the major form of infiltrative restrictive cardiomyopathies. Its prognosis is poor, but several therapies are being investigated and implemented. Storage cardiomyopathies are the consequence of accumulation of substances due to genetic defects affecting metabolic pathways; we review Fabry disease, glycogen storage diseases and hemochromatosis.
Constrictive Pericarditis: multimodal imaging
2019, Revista Colombiana de Cardiologia
La pericarditis constrictiva es una entidad clínica que se manifiesta con signos y síntomas de insuficiencia cardiaca diastólica, causada por un pericardio anormalmente engrosado y rígido, o ambos, y disminución consecuente del llenado ventricular debido a menor distensibilidad. Dentro de las causas de pericarditis constrictiva está la inflamación por infección (viral, micobacterial o fúngica), enfermedades del tejido conectivo o cirugía cardiaca, entre otros. La ecocardiografía transtorácica de dos dimensiones (2 D) y el modo Doppler constituyen la primera herramienta diagnóstica en la evaluación de insuficiencia cardiaca y pueden identificar pericarditis constrictiva en la mayoría de pacientes mediante técnicas en movimiento real y hallazgos hemodinámicos. Asimismo, la tomografía computarizada y la resonancia magnética proveen información adicional para el diagnóstico y manejo de la pericarditis constrictiva, y son particularmente útiles cuando los hallazgos ecocardiográficos no son concluyentes. La evaluación hemodinámica por cateterismo cardíaco ocasionalmente puede aportar información adicional en casos en los que las imágenes no-invasivas demuestran hallazgos sugerentes o no concluyentes de pericarditis constrictiva.
Constrictive pericarditis is a clinical condition that demonstrates signs and symptoms of diastolic heart failure, caused by an abnormally enlarged and rigid pericardium, and a subsequent decrease in ventricular filling due to lower distensibility. Among the causes of constrictive pericarditis are the inflammation due to infection (viral, mycobacterial, or fungal), connective tissue diseases, or cardiac surgery. Two-dimensional (2-D) transthoracic ultrasound and in the Doppler mode is the main diagnostic tool in the evaluation of heart failure. It can also identify constrictive pericarditis in the majority of patients by means of real-time movement techniques and haemodynamic findings. Likewise, computed tomography and magnetic resonance provide additional information for the diagnosis and management of constrictive pericarditis, and are particularly useful when the cardiac ultrasound findings are inconclusive. The haemodynamic evaluation by cardiac catheterisation can occasionally provide additional information in cases in which the non-invasive images show suggestive of inconclusive findings of constrictive pericarditis.
Pericardial Disease
2019, Essential Echocardiography: A Companion to Braunwald's Heart Disease
The pericardium is a thin-walled structure composed of two layers, a serous visceral layer (epicardium) and a fibrous parietal layer, both of which surround and protect the heart. Between these layers, up to 50 mL of pericardial fluid normally cushion the heart while the pericardium serves as a barrier to inflammation and infection. Limited epidemiologic data are available for the incidence and prevalence of pericardial disease. Depending on the clinical setting, the etiology of pericardial disease may be attributed to infection, autoimmune, postmyocardial infarction, malignant, metabolic, traumatic, drug-related, congenital, or iatrogenic causes. Transthoracic echocardiography is the first line noninvasive test of choice in patients with suspected pericardial disease. Although the pericardium can be assessed with M-mode, two-dimensional, or three-dimensional echocardiography, two-dimensional echocardiography is most frequently used for assessing pericardial effusions and their hemodynamic significance and also serves as the most cost-effective imaging modality. This chapter reviews the echocardiographic evaluation of the pericardium in various pericardial syndromes: pericardial effusion, pericarditis, pericardial constriction, and other pericardial disorders.

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Comparison of new Doppler echocardiographic methods to differentiate constrictive pericardial heart disease and restrictive cardiomyopathy

Abstract

Section snippets

Study population

Pulmonary venous flow

Discussion

Mayo Clin Proc

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am Heart J

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am Heart J

Mayo Clin Proc

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

Doppler echocardiographic assessment of constrictive pericarditis, cardiac amyloidosis, and cardiac tamponade

Cleve Clin J Med