Differentiation of constrictive pericarditis and restrictive cardiomyopathy by Doppler echocardiography.

Abstract

Doppler ultrasound recordings of mitral, tricuspid, aortic, and pulmonary flow velocities, and their variation with respiration, were recorded in 12 patients with a restrictive cardiomyopathy and seven patients with constrictive pericarditis. Twenty healthy adults served as controls. The patients with constrictive pericarditis showed marked changes in left ventricular isovolumic relaxation time and in early mitral and tricuspid flow velocities at the onset of inspiration and expiration. These changes disappeared after pericardiectomy and were not seen in patients with restrictive cardiomyopathy or in normal subjects. The deceleration time of early mitral and tricuspid flow velocity was shorter than normal in both groups, indicating an early cessation of ventricular filling, but only patients with restrictive cardiomyopathy showed a further shortening of the tricuspid deceleration time with inspiration. Diastolic mitral and tricuspid regurgitation was also more common in the patients with restrictive cardiomyopathy. These results suggest that patients with constrictive pericarditis and restrictive cardiomyopathy can be differentiated by comparing respiratory changes in transvalvular flow velocities. In addition, although baseline hemodynamics in the two groups were similar, characteristic changes were seen with respiration that suggest differentiation of these disease states may also be possible from hemodynamic data. (Circulation 1989;79:357-370) T he differentiation between constrictive pericarditis and restrictive cardiomyopathy is often difficult by clinical examination as well as with hemodynamic studies. Although elevated and "equalized" diastolic pressures that demonstrate a "dip and plateau" pattern at catheterization suggest a constrictive process, restrictive cardiomyopathy may show similar findings. Furthermore, diastolic pressures may not be equalized in patients who have constriction when additional cardiac pathology is present.1-4 In a patient with constrictive pericarditis, we noted a striking respiratory variation in early mitral and tricuspid flow velocities recorded by Doppler ultrasound. To assess the possible diagnostic value of this finding, transvalvular flow velocities were recorded with respiration in patients with constrictive pericarditis, stud-

Differentiation Between Restrictive Cardiomyopathy and Constrictive Pericarditis by Early Diastolic Doppler Myocardial Velocity Gradient at the Posterior Wall

“…[1][2][3][4][5][6] The evaluation of respiratory variations of Doppler bloodflow velocities alone were inconclusive in 2 patients for transmitral velocity pattern and in 2 patients for hepatic vein flow. For the entire study group, the information from both transmitral and hepatic vein Doppler blood flow assisted the diagnosis of CP in all but one patient.…”

“…Although in CP patients there is an increase in ventricular interaction 29 and a dissociation of intrathoracic-intracardiac pressure changes with respiration, 5,6,30 both CP and RCM may have similar clinical manifestations, which are related to decreased LV compliance. 31 However, the mechanism leading to the decrease in chamber compliance is different.…”

“…1 These parameters are based on conventional M-mode, 2,3 2D images, 4 and Doppler blood-flow patterns. [5][6][7][8][9] The respiratory variation in transmitral velocity blood flow is the most frequently used parameter to differentiate RCM from CP. 5,6 However, respiratory variation can also be observed in patients with chronic obstructive airway disease.…”

“…[5][6][7][8][9] The respiratory variation in transmitral velocity blood flow is the most frequently used parameter to differentiate RCM from CP. 5,6 However, respiratory variation can also be observed in patients with chronic obstructive airway disease. 10 Also, a considerable percentage of CP patients do not demonstrate respiratory variation in their blood-flow velocities.…”

Extracardiac Medical and Neuromuscular Implications in Restrictive Cardiomyopathy

“…1) do not show respiratory-dependent variations in their amplitudes, constrictive pericarditis is very unlikely. 35 Plasma brain-natriuretic peptide levels are higher in RCMP than in constrictive pericarditis. 27 …”