Left ventricular strain‐curve morphology to distinguish between constrictive pericarditis and restrictive cardiomyopathy

Abstract

Aims To distinguish between constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM) using cardiac magnetic resonance feature tracking (CMR‐FT) left ventricle (LV) diastolic time–strain curve patterns and myocardial strain. Methods and Results A total of 32 CP patients, 27 RCM patients, and 25 control subjects were examined by CMR‐FT and analysed for global strain, segmental strain, and LV time–strain curve patterns in the longitudinal, circumferential, and radial directions. Speckle tracking echocardiography (STE) strain imaging was performed in some cases. The peak global longitudinal strain (GLS) and global circumferential strain (GCS) of the RCM group were lower than those of the CP group. GLS [median (interquartile range) CP vs. RCM: −11.15 (−12.85, −9.35) vs. −6.5 (−8.75, −4.85), P < 0.001] and GCS (CP vs. RCM: −16.89 ± 5.11 vs. −13.37 ± 5.79, P < 0.001). In circumferential and radial directions, the strain ratios of the LV lateral/septal wall (LW/SW) of the CP group were significantly lower than those of the RCM group at the basal and mid segments. The CS ratio of LW/SW at the basal segment [CP vs. RCM: 0.95 (0.85, 1.25) vs. 1.43 (1.18, 1.89), P < 0.001] and mid segment [CP vs. RCM: 1.05 (0.92, 1.15) vs. 1.18 (1.06, 1.49), P = 0.026]. The RS ratio of LW/SW at the basal segment [CP vs. RCM: 0.97 (0.76, 1.37) vs. 1.55 (1.08, 2.31), P = 0.006] and mid segment [CP vs. RCM: 0.95 (0.70, 1.28) vs. 1.79 (1.32, 2.92), P < 0.001]. In the longitudinal and circumferential directions, the characteristic ‘plateau’ pattern of time–strain curves could be seen in the CP but not in the RCM during the diastole. The GCS ratio of 0–50%/50–75% diastolic period of the CP was higher than that of the RCM [CP vs. RCM: 17.01 (8.67, 23.75) vs. 5.38 (1.93, 11.24), P = 0.001], while the GCS ratio of 50–75%/75–100% diastolic period was lower than that of the RCM [CP vs. RCM: 0.36 (0.15, 1.67) vs. 1.12 (0.70, 5.58), P < 0.001]. The peak GLS (sensitivity, 85%; specificity, 78%) and the GCS ratio of 0–50%/50–75% diastolic period (sensitivity, 88%; specificity, 73%) had higher differential diagnosis value. Conclusions The CMR‐FT could distinctly differentiate CP from RCM based on LV myocardial strain and LV time–strain curve patterns. The characteristic ‘plateau’ pattern of the time–strain curve is specific for CP and not RCM and this curve can also be duplicated by STE.

Multimodality Imaging of Constrictive Pericarditis: Pathophysiology and New Concepts

“…This approach can help to identify inflammation, and therefore anti-inflammatory therapy can be considered [ 24 ]. Myocardial tissue tracking with CMR has also been utilized and has been found helpful in differentiating cases of CP from RCM, but its use has not been widely adopted due to limited availability [ 4 , 60 , 61 ].…”

Case Report: “Gourd-Shaped” Heart Strangled by Localized Annular Calcification of the Left Ventricle: A Rare Case of Constrictive Pericarditis

“…However, due to the relatively preserved myocardial motion and function, this patient did not have a significant decrease in global strain rate. In addition, the characteristic "plateau" pattern of CP in LV global and regional mid-segment time-strain curves corresponded to the location of calcified pericardium (15). Balancing risks and benefits of this patient, we decided to postpone the operation, follow up the patient regularly, and pay close attention to the progressive course.…”

Epicardial adipose tissue and pericardial constraint in heart failure with preserved ejection fraction

“…Both conditions have a typical clinical and haemodynamic presentation, but the underlying pathophysiology is strikingly different. [15][16][17] In restrictive cardiomyopathy, the reduced compliance is mainly caused by abnormal elastic properties of the myocardium itself, whereas in constrictive pericarditis, it is caused by the consequent loss of normal elasticity in the pericardial sac or its content. [15][16][17] The latter typically results in impaired ventricular filling in mid and late diastole, and rapid ventricular filling occurs primarily in the early phase of diastole.…”