Accuracy and pitfalls of early diastolic motion of the mitral annulus for diagnosing constrictive pericarditis by tissue Doppler imaging


      Mitral annular velocities are reportedly useful in diagnosing constrictive pericarditis (CP); however, their exact efficacy in larger clinical settings remains unevaluated. This study reexamined the role of longitudinal tissue Doppler imaging in diagnosing CP in clinical practice. Tissue velocity imaging (GE Vingmed System Five) was performed in 122 subjects (87 referred with clinically suspected CP and 35 age- and sex-matched controls). Of the 87 subjects with suspected CP, 45 (51.7%) had CP confirmed at surgery, 11 (12.6%) had restrictive heart disease, 20 (23.0%) had right heart failure due to cor pulmonale, and the other 11 (12.6%) had old pericardial effusions and no hemodynamic evidence of constriction on follow-up echocardiography. Of the 45 patients with CP, mitral early diastolic (Ea) annular velocities from septal and lateral regions were normal (≥8 cm/s) in 40 (88.9%) and decreased (<8 cm/s) in 1 or both regions in 5 (3 with left ventricular systolic dysfunction, 2 with extensive mitral annular calcification). Of 11 patients with restrictive cardiomyopathy, 8 (72.7%) had reduced Ea (<8 cm/s) and 3 showed normal Ea velocity in 1 or both corners of the mitral annulus. All except 2 patients with right-sided heart failure from cor pulmonale and those with previous pericardial effusion had normal Ea velocities. A normal Ea velocity improved recognition of CP, particularly in the presence of nondiagnostic 2-dimensional or transmitral flow-Doppler imaging. The overall sensitivity and specificity for diagnosing CP using tissue Doppler incrementally with M-mode, 2-dimensional, and transmitral flow Doppler were 88.8% and 94.8%, respectively. Mitral annular velocities help with diagnosis and differentiation of CP in most cases, except in the presence of extensive annular calcification, left ventricular systolic dysfunction, or segmental nonuniformity in myocardial velocities.
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        • Hancock E.W
        Differential diagnosis of restrictive cardiomyopathy and constrictive pericarditis.
        Heart. 2001; 86: 343-349
        • Garcia M.J
        • Rodriguez L
        • Ares M
        • Griffin B.P
        • Thomas J.D
        • Klein A.L
        Differentiation of constrictive pericarditis from restrictive cardiomyopathy.
        J Am Coll Cardiol. 1996; 27: 108-114
        • Oki T
        • Tabata T
        • Yamada H
        • Abe M
        • Onose Y
        • Wakatsuki T
        • Fujinaga H
        • Sakabe K
        • Ikata J
        • Nishikado A
        • Iuchi A
        • Ito S
        Right and left ventricular wall motion velocities as diagnostic indicators of constrictive pericarditis.
        Am J Cardiol. 1998; 81: 465-470
        • Rajagopalan N
        • Garcia M.J
        • Rodriguez L
        • Murray R.D
        • Apperson-Hansen C
        • Stugaard M
        • Thomas J.D
        • Klein A.L
        Comparison of new Doppler echocardiographic methods to differentiate constrictive pericardial heart disease and restrictive cardiomyopathy.
        Am J Cardiol. 2001; 87: 86-94
        • Ha J.W
        • Oh J.K
        • Ommen S.R
        • Ling L.H
        • Tajik A.J
        Diagnostic value of mitral annular velocity for constrictive pericarditis in the absence of respiratory variation in mitral inflow velocity.
        J Am Soc Echocardiogr. 2002; 15: 1468-1471
        • Ha J.W
        • Oh J.K
        • Ling L.H
        • Nishimura R.A
        • Seward J.B
        • Tajik A.J
        Annulus paradoxus.
        Circulation. 2001; 104: 976-978
        • Hatle L.K
        • Appleton C.P
        • Popp R.L
        Differentiation of constrictive pericarditis and restrictive cardiomyopathy by Doppler echocardiography.
        Circulation. 1989; 79: 357-370
        • Klein A.L
        • Cohen G.I
        • Pietrolungo J.F
        • White R.D
        • Bailey A
        • Pearce G.L
        • Stewart W.J
        • Salcedo E.E
        Differentiation of constrictive pericarditis from restrictive cardiomyopathy by Doppler transesophageal echocardiographic measurements of respiratory variations in pulmonary venous flow.
        J Am Coll Cardiol. 1993; 22: 1935-1943
        • Oh J.K
        • Hatle L.K
        • Seward J.B
        • Danielson G.K
        • Schaff H.V
        • Reeder G.S
        • Tajik A.J
        Diagnostic role of Doppler echocardiography in constrictive pericarditis.
        J Am Coll Cardiol. 1994; 23: 154-162
        • Klodas E
        • Nishimura R.A
        • Appleton C.P
        • Redfield M.M
        • Oh J.K
        Doppler evaluation of patients with constrictive pericarditis.
        J Am Coll Cardiol. 1996; 28: 652-657
        • Sengupta P.P
        • Mohan J.C
        • Pandian N.G
        Tissue Doppler echocardiography.
        Indian Heart J. 2002; 54: 368-378
        • Arnold M.F
        • Voigt J.U
        • Kukulski T
        • Wranne B
        • Sutherland G.R
        • Hatle L
        Does atrioventricular ring motion always distinguish constriction from restriction? A Doppler myocardial imaging study.
        J Am Soc Echocardiogr. 2001; 14: 391-395
        • Veeragandham R.S
        • Goldin M.D
        Surgical management of radiation induced heart disease.
        Ann Thorac Surg. 1998; 65: 1014-1019
        • Veinot J.P
        • Edwards W.D
        Pathology of radiation-induced heart disease.
        Hum Pathol. 1996; 27: 766-773
        • Chello M
        • Mastroroberto P
        • Romano R
        • Perticone F
        • Marchese A.R
        Collagen network remodelling and left ventricular function in constrictive pericarditis.
        Heart. 1996; 75: 184-189
        • Vogel J.H
        • Horgan J.A
        • Strahl C.L
        Left ventricular dysfunction in chronic constrictive pericarditis.
        Chest. 1971; 59: 484-492
        • Kartha C.C
        Endomyocardial fibrosis, a case for the tropical doctor.
        Cardiovasc Res. 1995; 30: 636-643