Differentiation of restrictive cardiomyopathy from pericardial constriction: Assessment of diastolic function by radionuclide angiography

Abstract

Diastolic filling variables were studied in 12 patients with the hemodynamic features of constriction, of whom 5 had restrictive cardiomyopathy, 5 had pericardial constriction and 2 had combined pericardial constriction and restrictive cardiomyopathy. The values were compared with those in 10 normal subjects of comparable age. The filling fractions between 10% and 70% of the diastolic time interval were greater in patients with pericardial constriction than in those with restrictive cardiomyopathy (p less than 0.01 between 20% and 50%, p less than 0.05 at 10%, 60% and 70%), with no overlap. The filling fractions in patients with pericardial constriction were also greater than those in normal subjects between 10% and 60% of the diastolic time interval. The filling fraction was lower in patients with restrictive cardiomyopathy than in normal subjects at 40% of the diastolic time interval (p less than 0.05). The time to peak filling rate in patients with pericardial constriction was shorter (110 +/- 14 ms) than in those with restrictive cardiomyopathy (195 +/- 45 ms, p less than 0.01) or in normal subjects (173 +/- 32 ms, p less than 0.01). The percent of atrial contribution to left ventricular filling was higher in those with restrictive cardiomyopathy (45 +/- 17%) than in those with pericardial constriction (21 +/- 6%, p less than 0.05) or in normal subjects (24 +/- 9%, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

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“…They found that diastolic filling occurred more rapidly in patients with CP compared with RCM patients and normal subjects in the beginning 20-40% of diastole and reached a plateau at 50% of diastolic filling time compared to plateau at 75% of diastolic filling time in healthy volunteers [17]. They also found that time to peak diastolic filling was significantly shorter in CP than RCM and healthy volunteers [17]. This is significantly different from tamponade, where filling is restricted throughout diastole [13].…”

“…The presence of a thickened pericardium >4 mm on Cardiac Magnetic Resonance Imaging (CMR) supports a diagnosis of CP [16]. A normal endomyocardial biopsy helps to exclude RCM, but presence of non-specific inflammation or fibrosis may cloud the issue, and the 2 conditions may co-exist if the etiology is mediastinal irradiation [17]. In the past, tuberculosis was the predominant cause of CP, but has been replaced currently by previous cardiac surgery and radiotherapy to the mediastinum [18].…”

Nuclear imaging in cardiac amyloidosis

“…Aroney et al found no difference between LV peak filling rates normalized to end-diastolic volume in patients without cardiac disease and in patients with pericardial constriction or restrictive cardiomyopathy [68]. However, Gerson et al found a considerably greater LV peak filling rate in patients with pericardial constriction [69].…”

Extracardiac Medical and Neuromuscular Implications in Restrictive Cardiomyopathy

“…4,31 Restrictive cardiomyopathy can be differentiated from constrictive pericarditis, which presents with a similar clinical picture, by cardiac catheterization, radionuclide angiography, computed tomography, cardiac magnetic resonance imaging, and echocardiography by application of conventional Doppler and tissue-Doppler imaging. [32][33][34] If the Doppler tracings of the transmitral flow (Fig. 1) do not show respiratory-dependent variations in their amplitudes, constrictive pericarditis is very unlikely.…”

“…Endomyocardial biopsy in patients with suspected RCMP may reveal acute myocarditis. 32 In idiopathic RCMP, endomyocardial biopsy demonstrates interstitial fibrosis, predominantly pericellular, perivascular fibrosis, myocyte hypertrophy, attenuation, and degeneration. 4,10,11,37 Immunofluorescent staining, immunohistochemical studies, and electron microscopy may be necessary for detecting diseases such as eosinophilia-myalgia syndrome, desminopathy, cystinosis, and Fabry's disease.…”