Role of Echocardiography in the Diagnosis of Constrictive Pericarditis
Section snippets
Pathophysiology of Constrictive Pericarditis
In CP, the visceral pericardium and the parietal pericardium are fibrosed and fused together,2 although not necessarily always thickened (Figure 2A).12 Calcification can result in the formation of pericardial calcium plaques (eggshell appearance), which may penetrate into the myocardium.2 The incidence and prevalence of pericardial calcification is dependent on the underlying cause of CP and is less commonly encountered in developing nations as the incidence of tuberculous pericarditis has
Echocardiographic Diagnosis of Constrictive Pericarditis
The echocardiographic diagnosis of CP was originally based on M-mode echocardiographic findings and subsequently on 2-dimensional echocardiography and Doppler hemodynamics in response to the respiratory cycle. More recently, newer echocardiographic techniques, such as pulsed tissue Doppler, color Doppler tissue imaging (DTI), and speckle-tracking imaging, have been used to assess the unique changes in global and regional myocardial function seen in CP. However, while interpreting the role of
Pericardium
The detection of increased pericardial thickness may be of help in making a diagnosis of CP,35 but M-mode38 and 2-dimensional echocardiography62 show poor sensitivity and correlation with pathologic specimen measurements. Transesophageal echocardiography, on the other hand, because of superior resolution, showed high sensitivity (95%) and specificity (86%) to detect a pericardium ≥3 mm thick.63 Nevertheless, about 1 in 5 patients with CP have normal pericardium,12 and the isolated finding of
Conclusion
Multiple echocardiographic findings are used to confirm a diagnosis of CP, but demonstration of enhanced cardiac intracavitary blood flow variations during respiration, abnormal interventricular septal motion, and normal longitudinal mitral annular velocity provide the greatest diagnostic yield. In the presence of a mixed physiology (pericardial constraint combined with myocardial dysfunction), the diagnosis and therefore referral for pericardiectomy remain challenging. In such patients, the
References (70)
- et al.
The hemodynamics of cardiac tamponade and constrictive pericarditis
Am J Cardiol
(1970) - et al.
Early and late results of pericardiectomy for constrictive pericarditis
J Thorac Cardiovasc Surg
(1985) - et al.
Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy
J Am Coll Cardiol
(2004) - et al.
Pathology of radiation-induced heart disease: a surgical and autopsy study of 27 cases
Hum Pathol
(1996) - et al.
Left ventricular filling in differentiating restrictive amyloid cardiomyopathy and constrictive pericarditis
Am J Cardiol
(1981) - et al.
Constrictive pericarditis versus restrictive cardiomyopathy: the role of Doppler echocardiography in differential diagnosis
Int J Cardiol
(1991) - et al.
Diagnostic role of Doppler echocardiography in constrictive pericarditis
J Am Coll Cardiol
(1994) - et al.
Respiratory variation of mitral and pulmonary venous Doppler flow velocities in constrictive pericarditis before and after pericardiectomy
J Am Soc Echocardiogr
(2001) - et al.
Comparison of mitral inflow and superior vena cava Doppler velocities in chronic obstructive pulmonary disease and constrictive pericarditis
J Am Coll Cardiol
(1998) - et al.
Diagnosis of constrictive pericarditis by pulsed Doppler echocardiography of the hepatic vein
Am J Cardiol
(1989)
Differentiation of constrictive pericarditis from restrictive cardiomyopathy by Doppler transesophageal echocardiographic measurements of respiratory variations in pulmonary venous flow
J Am Coll Cardiol
Difference in the respiratory variation between pulmonary venous and mitral inflow Doppler velocities in patients with constrictive pericarditis with and without atrial fibrillation
J Am Coll Cardiol
Doppler evaluation of patients with constrictive pericarditis: use of tricuspid regurgitation velocity curves to determine enhanced ventricular interaction
J Am Coll Cardiol
Comparison of new Doppler echocardiographic methods to differentiate constrictive pericardial heart disease and restrictive cardiomyopathy
Am J Cardiol
M-mode echocardiography in constrictive pericarditis
J Am Coll Cardiol
Septal bounce, vena cava plethora, and pericardial adhesion: informative two-dimensional echocardiographic signs in the diagnosis of pericardial constriction
J Am Soc Echocardiogr
Doppler tissue imaging improves assessment of abnormal interventricular septal and posterior wall motion in constrictive pericarditis
J Am Soc Echocardiogr
Echocardiography: pericardial thickening and constrictive pericarditis
Am J Cardiol
Myocardial wall velocity assessment by pulsed Doppler tissue imaging: characteristic findings in normal subjects
Am Heart J
Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures
J Am Coll Cardiol
Incremental value of combining systolic mitral annular velocity and time difference between mitral inflow and diastolic mitral annular velocity to early diastolic annular velocity for differentiating constrictive pericarditis from restrictive cardiomyopathy
J Am Soc Echocardiogr
Differentiation of constrictive pericarditis from restrictive cardiomyopathy: assessment of left ventricular diastolic velocities in longitudinal axis by Doppler tissue imaging
J Am Coll Cardiol
Differentiation of constrictive pericarditis from restrictive cardiomyopathy using mitral annular velocity by tissue Doppler echocardiography
Am J Cardiol
Right and left ventricular wall motion velocities as diagnostic indicators of constrictive pericarditis
Am J Cardiol
Accuracy and pitfalls of early diastolic motion of the mitral annulus for diagnosing constrictive pericarditis by tissue Doppler imaging
Am J Cardiol
Unique features of early diastolic mitral annulus velocity in constrictive pericarditis
J Am Soc Echocardiogr
Diagnostic value of mitral annular velocity for constrictive pericarditis in the absence of respiratory variation in mitral inflow velocity
J Am Soc Echocardiogr
Comparison of usefulness of tissue Doppler imaging versus brain natriuretic peptide for differentiation of constrictive pericardial disease from restrictive cardiomyopathy
Am J Cardiol
Color tissue Doppler myocardial velocities consistently underestimate spectral tissue Doppler velocities: impact on calculation peak transmitral pulsed Doppler velocity/early diastolic tissue Doppler velocity (E/Ea)
J Am Soc Echocardiogr
Myocardial and endocardial involvement in tuberculous constrictive pericarditis: difficulty in biopsy distinction from endomyocardial fibrosis as a cause of restrictive heart disease
Int J Cardiol
Disparate patterns of left ventricular mechanics differentiate constrictive pericarditis from restrictive cardiomyopathy
J Am Coll Cardiol Cardiovasc Imaging
Contribution of the pericardium to left ventricular torsion and regional myocardial function in patients with total absence of the left pericardium
J Am Soc Echocardiogr
Left ventricular structure and function: basic science for cardiac imaging
J Am Coll Cardiol
Diagnosis of constrictive pericarditis by two-dimensional echocardiography: Studies in a new experimental model and in patients
J Am Coll Cardiol
Pericardial thickness measured with transesophageal echocardiography: feasibility and potential clinical usefulness
J Am Coll Cardiol
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This work was supported in part by a grant-in-aid to Dr Sengupta from the American Society of Echocardiography (Morrisville, NC).
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Drs Dal-Bianco and Sengupta contributed equally to this work.