TISSUE
DOPPLER ECHOCARDIOGRAPHY DIFFERENTIATES CONSTRICTIVE PERICARDITIS FROM
RESTRICTIVE CARDIOMYOPATHY BUT DOES NOT DISPLAY RESPIRATORY VARIATION AT
ALL MITRAL ANNULAR
MARGINS. M. Bashir, J.J. Pereira*, I.
Abdalla, R. D. Murray, J. Drinko, M.J. Garcia, J.D. Thomas, A. L. Klein. The
Cleveland Clinic Foundation, Cleveland, OH, USA. Objective: Measurement of the peak early velocity of longitudinal
axis expansion (Ea) using pulsed Tissue Doppler Echocardiography
(TDE) at the lateral margin of the mitral annulus is clinically
useful in distinguishing constrictive pericarditis (CP) from restrictive
cardiomyopathy (RCM). However, the use of annular margins other
than the lateral to differentiate CP from RCM has not been validated.
Furthermore, respiratory variation of Ea at any of the
annular locations has not been assessed. Methods: We studied 11 patients with either CP or RCM. All
patients were categorized on the basis of clinical assessment and diagnostic
tests including cardiac catheterization, MRI, transthoracic and
transoesophageal Doppler echocardiography, endomyocardial biopsy and surgical
findings. Patients with isolated right-sided CP were excluded. TDE was
performed from the apical 2 and 4-chamber views. Ea values were
obtained at the lateral, septal, anterior and inferior annular margins. Eavalues
were recorded for inspiration, expiration and end-apnea and respiratory
variation (%Ea)è was calculated. Results: There were 5
patients with CP (age= 57± 5 years, 4 male,
LVEF= 61± 14%) and 6
patients with RCM (age= 62± 11 years, 4
male, LVEF= 48± 11%). Results are summarised below. Margin Lateral Septal Anterior Inferior P Ea
CP (cm/s) 12.6
± 3.1 14.6
± 4 13.8
± 5.5 15.8
± 3.8 NS Ea
RCM(cm/s) 6.3
± 3.6 5.1
± 2 4.7
± 1.7 4.4
± 1.8 NS P 0.019 0.002 0.0097 0.0005 %Ea
CP (%) -13
± 12 -8
± 15 -9
± 30 -16
± 22 NS %Ea
RCM (%) -6
± 10 -12
± 12 -14
± 13 -8
± 15 NS P NS NS NS NS è(%Ea )=(Ea
expiration - Ea inspiration
/ Ea expiration) X 100% Conclusions: 1) A higher Ea
velocity distinguishes CP from RCM. 2) The septal, anterior and inferior
margins are equally useful as the lateral. 3) There is no significant
difference in the respiratory variation of Ea velocities between CP and RCM at
any of these annular margins.
