Systolic time intervals in constrictive pericarditis and severe primary myocardial disease

Armstrong, T.G.; Lewis, B. S.; Gotsman, Mervyn S.

doi:10.1016/0002-8703(73)90520-6

Cited by 25 publications

(4 citation statements)

References 11 publications

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“…This has been reviewed in detail by Harris (1974), and shown to be true not only for primary myocardial disease (Spodick et al, 1972;Armstrong et al, 1973), but also for the myocardial disease occurring in hypertension (Tarazi et al, 1969), valvar heart disease, or coronary artery disease (Jezek, 1963;Pouget et al, 1971;Meng et al, 1976). However, analysis of the underlying disturbance has been limited by difficulties in the definition of myocardial contractility.…”

Section: Discussionmentioning

confidence: 99%

Mechanisms of prolongation of pre-ejection period in patients with left ventricular disease.

Chen¹,

Gibson²

1979

Heart

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SUMMARY In order to determine the mechanism underlying prolongation of the pre-ejection period in patients with left ventricular disease, 11 patients with congestive cardiomyopathy and 29 with coronary artery disea3e, 10 of whom were taking beta-adrenergic blocking drugs, were studied non-invasively. Recordings of carotid pulse, and apex, phon-, and echocardiogram were obtained. In the absence of treatment with beta-blocking drugs, prolongation of pre-ejection period correlated closely with incoordinate left ventricular wall movement during isovolumic contraction assessed from simultaneous apex and echocardiograms. There was no correlation between pre-ejection period index (PEPI) and end-diastolic dimension and PEPI correlated poorly with fractional shortening and peak Vcf. A PEPI of greater than 140 ms was associated with incoordinate contraction in all but one case, and of less than 140 ms with normal contraction in all. Therapeutic doses of beta-blocking drugs caused prolongation of PEPI to a greater extent than would have been predicted from wall movement during isovolumic contraction. Incoordinate left ventricular contraction and a negative inotropic effect both therefore prolong PEPI, but by different mechanisms, whose effects can be separated in individua patients using non-invasive methods based on echocardiography.Prolongation of pre-ejection period is commonly used to detect the presence of left ventricular disease, though the mechanism of this prolongation of pre-ejection period is obscure. A reduction in 'contractility' is frequently invoked, but this term is not adequately defined, and means little more than the presence of clinical evidence of left ventricular disease. We have, therefore, measured pre-ejection period and other systolic time intervals in patients with ischaemic heart disease or cardiomyopathy, analysing any impairment of left ventricular function at rest in terms of abnormal cavity size, incoordinate contraction, and reduced peak systolic rate of wall movement, measured echocardiographically. These observations were compared with those made during chronic administration of beta-blocking drugs in therapeutic dosage. MethodsSystolic time intervals were measured and echocardiographic examinations were performed in 40 patients, who were divided into the following groups:Group 1: 11 patients with congestive cardiomyo-

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Section: Discussionmentioning

confidence: 99%

Mechanisms of prolongation of pre-ejection period in patients with left ventricular disease.

Chen¹,

Gibson²

1979

Heart

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“…1 ) is followed by a rapid early diastolic ascent, which ends in a premature H wave and plateau contour [5, 9,10] (the X descent is variable, but may be well preserved). This sign corre sponds to the 'diastolic venous collapse' first described by Friedrich in 1855, and was considered the most con sistent physical sign in CP by Paul Wood [5], Tavel emphasizes the prematurity of the V wave, which in CP precedes A2 or follows it by not more than 0.03 s. Sys tolic time intervals are useful in CP to the extent that a PEP/LVET is less than 0.5 in CP but exceeds 0.5 in car diomyopathy, which may resemble CP in clinical presen tation [12], This criterion was of course more important before the advent of echocardiography than it is now. …”

Section: Phonocardiography and Pulse Tracingsmentioning

confidence: 99%

The Noninvasive Diagnosis of Constrictive Pericarditis

D’Cruz¹

1990

Am J Noninvas Cardiol

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Until the mid-20th century, the noninvasive diagnosis of constrictive pericarditis (CP) was based on a typical constellation of physical signs and detection of pericardial calcification on the chest X-ray. The introduction of phonocardiography, apexcardiography and jugular venous pulse tracings made it possible to record in graphic form certain important physical signs such as the pericardial ‘knock’ and prominent jugular venous Y descent. During the 1970s, the availability of M-mode echocardiograms recorded on strip charts was an important advance, because it permitted imaging of the presence and extent of pericardial thickening or calcification. It also enabled the cardiologist to visualize and time certain abnormalities of motion of the ventricular septum, ventricular wall or pulmonic valve, each of which was hailed, when first introduced, as a ‘new echo sign of CP’. However, most such signs are nonspecific, not consistently present, or subtle to perceive. On the two-dimensional echogram, typical appearances include normal to small ventricles within a rigid thick pericardial shell, with abrupt halting of ventricular expansion early in diastole, and biatrial dilatation. The Doppler pattern of transmitral flow shows diagnostic promise, in particular an abnormally short deceleration phase of rapid early left ventricular filling indicates ‘restrictive’ or ‘constrictive’ ventricular pathophysiology. Recent imaging techniques such as computed tomography and magnetic resonance imaging also have a diagnostic role in CP inasmuch as they may provide better visualization of the extent and degree of thickening of the whole pericardial perimeter than can be achieved by cardiac ultrasound. In conclusion, the diagnosis of CP depends on assessment of physical signs and noninvasive investigations taken together. CP may be suspected if several échocardiographie ‘signs’ are evident in the same patient, especially if pericardial thickening and normal left ventricle size, contraction and wall thickness are noted in a patient with frank apparent right-sided congestive failure but no significant valve disease.

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“…Several investigators utilizing adults have reported that the left ventricular systolic time intervals are usually normal in constrictive pericarditis [1,11,18,20]. According to Khullar and Lewis [18] and others [11] evaluating adults, left ventricular systolic time intervals can be used to clearly separate constrictive pericarditis from restrictive cardiomyopathy patients.…”

Section: Left Ventricular Ejection Phase Parametersmentioning

confidence: 99%

M-mode echocardiographic findings in children with idiopathic restrictive cardiomyopathy

et al. 1984

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The M-mode echocardiographic findings in five pediatric patients, ages 4-15 years, with primary idiopathic restrictive cardiomyopathy, diagnosed by cardiac catheterization, and of 12 normal children (control group) are presented. The M-mode echocardiographic findings in patients with restrictive cardiomyopathy were (1) normal left and right ventricular end-diastolic dimension, (2) normal left ventricular posterior wall and interventricular septal thickness (three patients) or mild concentric hypertrophy (two patients), (3) normal opening and closing velocity of the mitral valve, (4) consistently enlarged left atrium (more than 40 mm) in all, and (5) right ventricular systolic time intervals compatible with pulmonary artery hypertension. The left ventricular ejection phase parameters (systolic time intervals, shortening fraction, and mean velocity of circumferential fiber shortening) were normal. Left ventricular relaxation phase parameters (diastolic function) were abnormal. The isovolumic relaxation time index was prolonged, 68 +/- 40 ms (+/- SD), in the study group as compared with 11 +/- 6 ms (+/- SD) in the control group (P less than 0.001). Percent relaxation of left ventricular posterior wall endocardium at 50% of diastole was decreased, 58 +/- 4% (+/- SD), in the study group as compared with 85 +/- 6% (+/- SD) in the control group (P less than 0.005). We conclude that M-mode echocardiography provides a relatively useful and specific noninvasive method for the diagnosis of primary restrictive cardiomyopathy in pediatric patients.

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Systolic time intervals in constrictive pericarditis and severe primary myocardial disease

Cited by 25 publications

References 11 publications

Mechanisms of prolongation of pre-ejection period in patients with left ventricular disease.

Mechanisms of prolongation of pre-ejection period in patients with left ventricular disease.

The Noninvasive Diagnosis of Constrictive Pericarditis

M-mode echocardiographic findings in children with idiopathic restrictive cardiomyopathy

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