This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Schoenfeld, M. H. Articles by Palacios, I. F. Search for Related Content PubMed PubMed Citation Articles by Schoenfeld, M. H. Articles by Palacios, I. F.

Circulation, Vol 75, 1012-1017, Copyright © 1987 by American Heart Association

ARTICLES

Restrictive cardiomyopathy versus constrictive pericarditis: role of endomyocardial biopsy in avoiding unnecessary thoracotomy

MH Schoenfeld, EW Supple, GW Dec Jr, JT Fallon and IF Palacios

Despite careful clinical, noninvasive, and hemodynamic assessment of patients with constrictive/restrictive physiology, the differentiation of restrictive cardiomyopathy from constrictive pericarditis remains difficult. We examined the role of right ventricular endomyocardial biopsy in defining the underlying process in 54 patients with evidence of constrictive/restrictive physiology, including 38 patients with profound symptoms of heart failure in whom diagnostic/therapeutic thoracotomy was contemplated (group I) and 16 patients with milder symptoms (group II). All patients in group I had NYHA class III or IV heart failure with depressed cardiac index (mean 2.5 liters/min/m2), right atrial hypertension (mean 15 mm Hg), and normal left ventricular ejection fraction (mean 59%). Endomyocardial biopsy identified a specific source of restrictive cardiomyopathy in 15 of 38 patients (39%) (11 amyloid, four myocarditis). Of the 23 remaining patients with either normal biopsy findings or nonspecific abnormalities on biopsy, 18 had intraoperative or autopsy evaluation of their pericardium, and constriction was found in 14 (77%). A specific form of restrictive cardiomyopathy was also identified in four of the 16 patients with milder symptoms (group II). We conclude that endomyocardial biopsy is useful in patients with severe constrictive/restrictive physiology. It identifies a large subset of patients with specific forms of restrictive cardiomyopathy in whom thoracotomy should be avoided. It supports the need for thoracotomy and the likelihood of finding pericardial constriction in patients without specific pathologic findings.

This article has been cited by other articles:

				M. Schwefer, R. Aschenbach, J. Heidemann, C. Mey, and H. Lapp Constrictive pericarditis, still a diagnostic challenge: comprehensive review of clinical management Eur. J. Cardiothorac. Surg., September 1, 2009; 36(3): 502 - 510. [Abstract] [Full Text] [PDF]

				L. van Heerebeek, N. Hamdani, M. L. Handoko, I. Falcao-Pires, R. J. Musters, K. Kupreishvili, A. J.J. Ijsselmuiden, C. G. Schalkwijk, J. G.F. Bronzwaer, M. Diamant, et al. Diastolic Stiffness of the Failing Diabetic Heart: Importance of Fibrosis, Advanced Glycation End Products, and Myocyte Resting Tension Circulation, January 1, 2008; 117(1): 43 - 51. [Abstract] [Full Text] [PDF]

				W. C. Little and G. L. Freeman Pericardial Disease Circulation, March 28, 2006; 113(12): 1622 - 1632. [Full Text] [PDF]

				G. Hahalis, A.S. Manolis, D. Apostolopoulos, D. Alexopoulos, A.G. Vagenakis, and N.C. Zoumbos Right ventricular cardiomyopathy in {beta}-thalassaemia major Eur. Heart J., January 2, 2002; 23(2): 147 - 156. [Abstract] [Full Text] [PDF]

				E W. Hancock CARDIOMYOPATHY: Differential diagnosis of restrictive cardiomyopathy and constrictive pericarditis Heart, September 1, 2001; 86(3): 343 - 349. [Full Text] [PDF]

				P. Palka, A. Lange, J. E. Donnelly, and P. Nihoyannopoulos Differentiation Between Restrictive Cardiomyopathy and Constrictive Pericarditis by Early Diastolic Doppler Myocardial Velocity Gradient at the Posterior Wall Circulation, August 8, 2000; 102(6): 655 - 662. [Abstract] [Full Text] [PDF]

				N. M. Ammash, J. B. Seward, K. R. Bailey, W. D. Edwards, and A. J. Tajik Clinical Profile and Outcome of Idiopathic Restrictive Cardiomyopathy Circulation, May 30, 2000; 101(21): 2490 - 2496. [Abstract] [Full Text] [PDF]

				L. H. Ling, J. K. Oh, J. F. Breen, H. V. Schaff, G. K. Danielson, D. W. Mahoney, J. B. Seward, and A. J. Tajik Calcific Constrictive Pericarditis: Is It Still with Us? Ann Intern Med, March 21, 2000; 132(6): 444 - 450. [Abstract] [Full Text] [PDF]

				S. S. Kushwaha, J. T. Fallon, and V. Fuster Restrictive Cardiomyopathy N. Engl. J. Med., January 23, 1997; 336(4): 267 - 276. [Full Text] [PDF]

				R. S. Vasan, E. J. Benjamin, and D. Levy Congestive Heart Failure With Normal Left Ventricular Systolic Function: Clinical Approaches to the Diagnosis and Treatment of Diastolic Heart Failure Arch Intern Med, January 22, 1996; 156(2): 146 - 157. [Abstract] [PDF]

				I. S. Nash and J. T. Fallon Case 2-1994- A 31-Year-Old Man With A Previous Pericardiectomy for Constrictive Pericarditis and Mitral Regurgitation N. Engl. J. Med., January 13, 1994; 330(2): 126 - 134. [Full Text]

				T. Katayama, K. Iwamoto, S. Ochi, Y. Honda, and K. Shigematsu Restrictive Cardiomyopathy Following Acute Myocarditis A Case Report Angiology, January 1, 1990; 41(1): 76 - 81. [Abstract] [PDF]

				L. C. Chow, H. C. Dittrich, and R. Shabetai Endomyocardial Biopsy in Patients with Unexplained Congestive Heart Failure Ann Intern Med, October 1, 1988; 109(7): 535 - 539. [Abstract] [PDF]