Comprehensive review of pericardial diseases using different imaging modalities

Importance of Imaging Methods for Diagnosing Constrictive Pericarditis Versus Restrictive Cardiomyopathy

“…On physical examination, Kussmaul's sign, paradoxical pulse, and cardiac auscultation with pericardial knock (protodiastolic sound) are common findings. 3,4 An electrocardiogram reveals no pathognomonic signs for the diagnosis. It is possible to find nonspecific S-T segment and T wave changes.…”

“…Also, CP due to tuberculosis has a high incidence of calcification. 2,3 Pericardial calcification can occur in the absence of CP, but it is usually less dense and irregularly distributed on an X-ray. It is important to differentiate CP from restrictive cardiomyopathy, as these conditions may present with similar clinical and hemodynamic findings but require different treatments.…”

“…Thus, to define whether there is a constrictive pattern, additional imaging is needed. 3 The echocardiogram is an important test used to define the CP pattern. Diagnostic findings include interventricular septum deviation that changes with breathing (septal bounce); diastolic flow reversal in the hepatic veins during expiration and normal or increased septal e´ wave velocity on tissue Doppler (>8 cm/second).…”

“…These three findings have a sensitivity of 87% and specificity of 91%. [3][4][5] Other changes are respiratory variations greater than 25% in mitral flow velocity and greater than 40% in tricuspid flow, polar strain map with greater sidewall, and reduced annulus reversus (transmitral e´ wave greater than lateral e´ wave). [3][4][5] CMR is usually the method of choice after echocardiography for CP assessments.…”

“…[3][4][5] Other changes are respiratory variations greater than 25% in mitral flow velocity and greater than 40% in tricuspid flow, polar strain map with greater sidewall, and reduced annulus reversus (transmitral e´ wave greater than lateral e´ wave). [3][4][5] CMR is usually the method of choice after echocardiography for CP assessments. The diagnostic accuracy of magnetic resonance imaging (MRI) is greater than 90%, but its main advantage is the ability to differentiate CP from restrictive cardiomyopathy.…”