M-mode echocardiography in constrictive pericarditis

Abstract

M-mode echocardiograms from 40 patients with proven constrictive pericarditis and 40 subjects without evidence of cardiac disease were reviewed for features previously described in constrictive pericarditis. In this large series, no single feature of the M-mode echocardiogram could be considered diagnostic, although a pattern of normal left ventricular size and systolic function, mild left atrial dilation, flattened diastolic left ventricular posterior wall motion and abnormal septal motion was found in most patients. It is concluded that the M-mode echocardiogram can provide findings suggestive of constrictive pericarditis but must be used in conjunction with hemodynamic and other studies to establish the diagnosis.

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.…”

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).…”

Constrictive pericarditis presenting with massive ascites without hemodynamic echocardiographic features

“…Because of elevated filling pressures, mitral and tricuspid inflow velocities can be pseudo-normalized In addition, there may be evidence of pericardial thickening in M-mode with the presence of parallel epicardial and pericardial tracings (also known as "railroad tracks"). [6] 2-D findings include dilatation of the IVC without inspiratory collapse and septal bounce of the interventricular septum. [7] Doppler echo demonstrates a fall of the mitral inflow velocity from 25%-40% and tricuspid velocity of > 40% in the cardiac cycle immediately following respiration, and hepatic vein flow reversal which is the most-specific echocardiographic finding for constriction.…”