Abstract 1838: Differentiation of Constrictive Pericarditis from Restrictive Cardiomyopathy: Assessment of Left Ventricular Systolic and Diastolic Velocities of the Mitral Annulus by Tissue Doppler Imaging
Introduction: Tissue Doppler imaging (TDI) analysis of mitral annulus (MA) motion has been suggested for the differentiation of constrictive pericarditis (CP) from restrictive cardiomyopathy (RCM).
Methods: We studied the relationship between the early transmitral flow velocity (E), the systolic (S′) and early diastolic component (E‘) of MA motion by TDI, and LV filling pressures in 42 consecutive patients (pts.) with diastolic heart failure of either proven pericardial (CP) or myocardial origin (RCM). All pts. underwent a complete echocardiographic and hemodynamic assessment.
Results: Out of the 42 pts. (mean age: 59±12 years) 27 had CP, and 15 RCM; 23 pts. (55%) had sinus rhythm, and 19 (45%) atrial fibrillation. Mean pulmonary arterial pressure was significant increased in pts. with RCM (33±10 vs. 26±5 mm Hg; p<0.05). The thickness of the interventricular septum (IVSD) was significant increased in pts. with RCM (14±4 vs. 9±1 mm). S′ assessed by TDI was significant higher in pts. with CP (septal MA: 6.4±1.9 cm/s vs. 3.5±1.0 cm/s, p<0.001; lateral MA: 6.7±2.3 cm/s vs. 3.6±1.2 cm/s, p<0.001). Pts. with CP showed a higher E’ both on the septal and lateral side of the MA (12.8±5.4 cm/s vs. 3.9±1.3 cm/s, and 11.4±3.8 cm/s vs. 4.4±1.7 cm/s, resp.; p<0.001). E’ was <8 cm/s in all RCM pts. and >8 cm/s in 23/27 CP pts (85%). The 4 CP pts. with E′ < 8 cm/s either showed severe pericardial calcification, systolic dysfunction, or post-radiation syndrome. Moreover, pts. with RCM showed a significant higher E/E′-Ratio (septal MA: 26±9 vs. 11±8 cm/s; p < 0.001).
Conclusion: TDI analysis of MA motion demonstrated decreased systolic and diastolic velocities in pts. with RCM and allows a differentiation between pts. with RCM and CP independent of cardiac rhythm. The diagnostic value of TDI analysis in CP can be limited in pts. with severe pericardial calcifications, systolic dysfunction and post-radiation syndrome.