Version May 2024
| Parameter | Favors constrictive pericarditis | Favors restrictive cardiomyopathy |
| Biomarkers | ||
| BNP | <100 pg/mL | >400 pg/mL |
| Echocardiographic parameters | ||
| Ventricular septal shift (bounce)* | Present | Absent |
| Inspiratory change in IVRT | Increased | No change |
| Pericardial thickness | Increased | Normal |
| Respirophasic changes in ventricular filling velocity¶Δ | Increased (as much as 30 to 40% variation) | Minimal (usually <10%) |
| Hepatic venous flow | Reversal of forward flow during expiration | Reversal of forward flow during inspiration |
| Color M-mode flow propagation | >100 cm/second | <45 cm/second |
| Early diastolic Doppler tissue velocity E' at mitral annulus | Normal or increased (>12 cm/second) | Normal or decreased (<8 cm/second) |
| "Annulus reversus"◊ | Yes | No |
| Strain analysis (absolute global longitudinal strain) | >16% | ≤10% |
| CMR parameters | ||
| Relative atrial volume ratio (LA/RA volume) | ≥1.5 | ≤1.1 |
| Late gadolinium enhancement | Pericardial enhancement common in constrictive pericarditis | Myocardial enhancement frequently noted in amyloidosis |
| Global longitudinal strain | Normal | Reduced |
| Ventricular interdependence (cine CMR maximal septal respiratory excursion) | >11% | <8% |
| Cardiac catheterization parameters | ||
| Respiratory change in LV and RV pressures | Discordant | Concordant |
| RAP/PCWP ratio | >0.77 | ≤0.77 |
BNP: B-type natriuretic peptide; IVRT: isovolumic relaxation time; CMR: cardiovascular magnetic resonance imaging; LA: left atrial; RA: right atrial; LV: left ventricular; RV: right ventricular; RAP: right atrial pressure; PCWP: pulmonary capillary wedge pressure.
* When septal shift is combined with either medial E' ≥9 cm/s or hepatic vein expiratory reversal ≥79%, the sensitivity and specificity for constrictive pericarditis are 87 and 91%, respectively.
¶ The ventricular filling velocity is highly influenced by the level of LA pressure. When LA pressure is greatly elevated in a patient with constrictive pericarditis, respiratory variation in ventricular filling may not be observed, whereas patients with lower LA pressure (ie, due to volume depletion or earlier stage of disease) may have more noticeable changes in ventricular filling velocities with respiration.
Δ The ability to assess respirophasic changes in ventricular filling velocities is challenging in patients with atrial fibrillation due to the presence of variable cardiac cycle length from beat to beat.
◊ Unlike in normal individuals, mitral lateral (and tricuspid lateral) annular E' velocities are often relatively reduced in patients with constrictive pericarditis ("annular reversus"). This reduction may be the result of lateral adhesion of the pericardium while the longitudinal movement of the septal annulus is unimpeded. These mechanics are not evident in restrictive cardiomyopathy.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
