Echocardiographic features of constrictive pericarditis.

Abstract

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.

Constrictive Pericarditis

“…Also, the net diastolic LV posterior wall endocardial movement posteriorly is less than 1 mm in CP compared with normal controls in whom the posterior wall endocardial posterior movement ranges from 1.5 to 4 mm. 15 There is no gradual downward motion in mid-diastole or with atrial systole. This sign, however, is not pathognomonic of CP.…”

“…25 Because the mechano-elastic properties of the myocardium are preserved in CP, the longitudinal mitral annular velocities are normal. 26,27 It has Circulation Journal Vol.72, October 2008 been reported that an early diastolic mitral annular velocity (Ea) >8 cm/s at the lateral or septal mitral annular corner and an Ea/E <0.11 can distinguish between patients with CP and those with RCM. 26 Mitral annular velocities are particularly useful in CP when a pronounced respiratory variation in peak mitral E velocities is not seen.…”

Transient constrictive pericarditis: causes and natural history

“…However, it should be noted that even a carefully performed echocardiogram may be inconclusive in differentiating CP from restrictive cardiomyopathy, and in these cases additional testing, including cardiac catheterization and even surgical exploration, may be required to establish the diagnosis. The two-dimensional and M-mode echocardiographic criteria for CP include abnormal ventricular septal motion (5,6), respiratory variation in ventricular size (7), and presence of a dilated inferior vena cava (7). The Doppler findings in CP, as described by Hatle et al (8), are both sensitive and specific (9).…”

Multimodality Imaging of Pericardial Diseases

“…Abrupt anterior or posterior motion of the IVS in early diastole is common in patients with CP (25). In classic CP, the IVS shows a brisk, early diastolic motion toward the LV during inspiration, followed by a rebound in the opposite direction during expiration (26).…”