Abstract 3910: Differentiation of Constrictive Pericarditis From Restrictive Cardiomyopathy: Usefulness of Systolic and Early Diastolic Mitral Annular Velocities Assessed by Tissue Doppler Imaging
Purpose: Echocardiographic Tissue Doppler Imaging (TDI) has been proposed as diagnostic tool for the differentiation between constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM). The aim of this study was a comprehensive TDI analysis of systolic (S′) and early diastolic (E′) velocities of the septal and lateral mitral annulus (MA) in patients with severe diastolic dysfunction caused either by CP or RCM.
Methods: 60 consecutive patients (pts.; 34 men, mean age 61±11 years), 34 pts. with proven CP and 26 pts with RCM due to cardiac amyloidosis were included in the study. 42 of the 60 pts. were in NYHA class III (70%).
Results: In pts with RCM systolic longitudinal velocity (S′) was significantly decreased when compared to CP (septal MA 4.1±1.5 cm/s vs. 7.3±2.1cm/s, p<0.001; lateral MA 4.3±1.9 cm/s vs. 7.0±1.9 cm/s; p<0.001). In addition, the RCM-group showed a significantly decreased early diastolic longitudinal velocity (E′), both on the septal (4.1±1.6 cm/s vs. 12.9±4.9 cm/s, p<0.001) and lateral side (4.8±1.9 cm/s vs. 11.3±3.7 cm/s; p<0.001) of the mitral annulus. Septal E′ was <8 cm/s in all pts with RCM. A cut-off value of E′ <8 cm/s showed a sensitivity of 100% and a specificity of 85.3% with respect to diagnose RCM with TDI (see figure⇓).
Conclusion: TDI provides an accurate discrimination between constrictive pericarditis and restrictive cardiomyopathy when using a cut-off value of 8 cm/s for S′ and E′, and a cut-off value of <0.11 for the E′/E ratio.