Biventricular Mechanics in Constrictive Pericarditis Comparison With Restrictive Cardiomyopathy and Impact of Pericardiectomy

Abstract

Background-The aim of our study was to compare myocardial mechanics of constrictive pericarditis (CP) with restrictive cardiomyopathy (RCM), or healthy controls; to assess the impact of pericardial thickening detected by cardiac magnetic resonance on regional myocardial mechanics in CP; and to quantitate the effect of pericardiectomy on myocardial mechanics in CP. Methods and Results-Myocardial mechanics were evaluated by 2-dimensional speckle tracking in 52 consecutive patients with CP who underwent cardiac magnetic resonance examination before pericardiectomy, 35 patients with RCM, and 26 control subjects. CP patients had selectively depressed left ventricular (LV) anterolateral wall strain (LWS) and right ventricular (RV) free wall longitudinal systolic strain (FWS) but preserved LV septal wall systolic strain (SWS

Diagnostic Concordance of Echocardiography and Cardiac Magnetic Resonance–Based Tissue Tracking for Differentiating Constrictive Pericarditis From Restrictive Cardiomyopathy

“…21,[38][39][40] We have also previously demonstrated that longitudinal shortening strain is significantly reduced in RCM compared with CP, reflecting marked impairment of endocardial function. 3 Similar observations were reported by Kusunose et al, 4 who additionally illustrated the incremental value of the lateral-toseptal strain ratio over regional velocities in discriminating CP from RCM. Because the free wall of the LV is tethered in CP, LV lateral wall shortening strains are seen to be lower than septal shortening strains.…”

“…We included patients presenting with heart failure with preserved EF (>50%) in whom the initial echocardiographic assessment suggested CP and who fulfilled at least 1 of 4 additional criteria: (1) surgical confirmation during pericardiectomy; (2) cardiac catheterization findings consistent with CP; (3) evidence of thickened pericardium (thickness >4 mm by CMR); or (4) evidence of increased LV-RV coupling (septal shift with respiration) by both echocardiography and CMR. 4,23,24 The catheterization criteria included ≥2 of the following criteria: (1) a difference between LV end-diastolic pressure and RV end-diastolic pressure of ≤5 mm Hg; (2) pulmonary arterial systolic pressure <55 mm Hg; (3) a ratio of RV end-diastolic pressure to RV systolic pressure of >1/3; (4) inspiratory decrease in pulmonary capillary wedge pressure/LV enddiastolic pressure difference of >5 mm Hg; and (5) systolic area index >1.1. 24 A total of 24 patients (86%) were referred for pericardiectomy, with preoperative cardiac catheterization in 22 patients (79%).…”

“…29 Global longitudinal strain (GLS) for both techniques was expressed as the average endocardial strain value from apical 4-and 2-chamber views as previously described because the apical 3-chamber view in patients with CP was frequently suboptimal. 4 To obtain differences in septal versus lateral wall deformation, LV septal wall strains and lateral wall strains were measured by averaging strains from 3 segments in each wall. The peak values for all strain parameters were recorded and analyzed.…”

“…Several echocardiographic measurements have been proposed to differentiate myocardial diseases from pericardial constriction. 3,4 Cardiac magnetic resonance (CMR) imaging has superior contrast-to-noise and signal-tonoise ratios, permitting accurate quantification of pericardial thickening and providing assessment of the entire thorax. 5 Because noninvasive imaging techniques continue to advance, the clinical differentiation of CP from RCM is based on the recognition of a cluster of structural, mechanical, and hemodynamic aberrations rather than a single structural or functional variable used in isolation.…”

Modern Possibilities of Speckle Tracking Echocardiography in Clinical Practice

“…Имеются данные о возможности использования для дифференциальной диагностики констриктивно-го перикардита и рестриктивной кардиомиопатии па-раметров региональной продольной систолической деформации, в частности, соотношения деформации миокарда боковой стенки ЛЖ к деформации миокар-да межжелудочковой перегородки [43].…”