SUMMARY The most characteristic echocardiographic features of 12 patients with constrictive pericarditis were compared with the findings in 10 normal volunteers. Left ventricular posterior wall (LVPW) "flatness" was quantified by measuring the diastolic change in distance from the crystal artifact to the LVPW endocardium. In 11 of 12 patients the net diastolic LVPW endocardial movement was < 1 mm. In 10 normal volunteers LVPW endocardium moved posteriorly in diastole from 1.5 to 4 mm (mean 2.2 ± 0.8).Abnormal septal motion was present in five of 12 patients with constriction. Pericardial thickness measured using standard damping techniques for both constriction and normal populations did not distinguish the two groups.The "flattening" of the left ventricular endocardium as quantified above verifies earlier qualitative observations and was the most consistent finding in this series of patients with constrictive pericarditis.THE RECOGNITION OF constrictive pericarditis is clinically important, but often difficult. Radiographic evidence may provide a clue, but is not diagnostic and may be absent. Noninvasive tests are of limited value in identifying the impaired ventricular filling which characterizes this disorder. While echocardiography is very useful in identifying pericardial fluid, specific diagnostic criteria for identifying constriction are not widely accepted.Feigenbaum' and others2'3 reported a "flat" motion of the posterior left ventricular wall during diastole corresponding to the abrupt transition of rapid ventricular filling to diastasis in patients with constrictive pericarditis.2' 3To date, this observation has not been quantified and applied to a series of patients with constrictive pericarditis. In this paper we report the echocardiographic features of 12 patients with pericardial constriction. We describe a method of quantifying the relative "flatness" of the posterior left ventricular wall endocardium and document the validity of this early observation.
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