The relative atrial volume ratio and late gadolinium enhancement provide additive information to differentiate constrictive pericarditis from restrictive cardiomyopathy

Abstract

BackgroundThe differentiation of constrictive pericarditis (CP) from restrictive cariomyopathy (RCM) is often difficult. This study sought to determine the clinical utility of cardiovascular magnetic resonance imaging (CMR) for differentiating both these disorders.MethodsTwenty-three patients with surgically documented CP, 22 patients with RCM and 25 normal subjects were included in the study. CMR yielded information about cardiac morphology, function and tissue characteristics. The left (LA) and right atrial (RA) volume was calculated using the area-length method. The relative atrial volume ratio (RAR) was defined as the LA volume divided by RA volume. Receiver operating characteristic curve analysis was used to test the ability of different variables in differentiating CP from RCM.ResultsThe maximal pericardial thickness in CP patients was significantly larger than in normal subjects and RCM patients. The RA volume index in RCM patients (90.5 ± 35.3 mL/m2) was significantly larger than in CP patients (71.4 ± 15.7 mL/m2, p = 0.006) and normal subjects (38.1 ± 9.0 mL/m2, p < 0.001). The LA volume index in RCM (96.0 ± 37.0 mL/m2) and CP patients (105.6 ± 25.1 mL/m2) was significantly larger than in normal subjects (39.5 ± 9.5 mL/m2, p < 0.001 for all). The RAR in CP patients (1.50 ± 0.29) was significantly larger than in RCM patients (1.12 ± 0.33, p < 0.001) and normal subjects (1.06 ± 0.20, p < 0.001). There were no differences between RCM patients and normal subjects in the RAR (p = 0.452). At a cut-off value of 1.32 for the RAR, the sensitivity was 82.6%, and the specificity was 86.4% in the detection of CP. Septal bounce was identified in 95.7% CP patients, in none of RCM patients and normal subjects. Late gadolinium enhancement (LGE) was present in 31.8% RCM patients and absence in all CP patients and normal subjects.ConclusionsCMR with LGE and RAR can facilitate differentiation of CP from RCM.

Cardiac magnetic resonance imaging in arrhythmogenic right ventricular cardiomyopathy: correlation to the QRS dispersion

“…Each section was then acquired in a single breath hold in 8-14s with 15-25 temporal phases per heartbeat; 15-20 minutes after injection of 0.2 mmol/kg of gadolinium diethylenetriamine pentaacetic acid (Magnevist, Schering, Berlin, Germany), the images of late gadolinium enhancement (LGE) were obtained in a contiguous set of short-axis sections covering the entire ventricle, and in long-axis views to detect areas of LGE using a phase-sensitive inversion recovery spoiled gradient echo sequence (TR/TE=8.7/3.4ms, slice thickness=6 mm, imaging matrix=256×256, FOV=350 mm, flip angle=15°). The sequence mentioned above was previously reported [11,12].…”

Restrictive cardiomyopathy: A review of literature on clinical status and meta-analysis of diagnosis and clinical management

“…Cardiac MRI is also useful for excluding other underlying infiltrative disorders that could explain the constrictive hemodynamics [96][97][98][99][100][101]. Although cardiac CT is not in common use in the diagnostic of RCM, it may be considered to provide additional information on pericardial calcification, which is a feature of constrictive pericarditis but absent in RCM.…”

“…After screening title, abstract and full article, against the inclusion criteria, thirteen (13) studies were included in the present metaanalysis [54,[90][91][92][93][94][95][96][97][98][99][100][101]. The studies were published between 1983 and 2014 with a combined population of 420 RCM patients.…”

“…They assessed various methods used in the differential diagnosis of RCM and the focus was largely discriminating RCM from constrictive pericarditis because the two disorders have characteristically indistinguishable hemodynamic abnormalities. The majority of the 13 included studies examined Doppler echocardiography [54,[90][91][92] and cardiac MRI [96][97][98][99], while fewer studies investigated laboratory tests [94,95], cardiac CT [100,101], and endomyocardial biopsy [93].…”

“…While theses echo studies suggest differences in hemodynamics between RCM and constrictive pericarditis, the differences are not sufficient for a definitive diagnosis. Advanced imaging techniques such as Cardiac CT and MRI studies assess pericardial thickness providing additional information for differential diagnosis of RCM and constrictive pericarditis as well as aid in the detection of other infiltrative conditions resulting in restrictive hemodynamics [96][97][98][99][100][101]. In addition, CT provides information in pericardial calcification but it is not definitive since in about 50% of patients with constrictive pericarditis do not develop calcified pericardium [101].…”