An approach to diagnosis of constrictive pericarditis

This is an approach to diagnosis of CP in patients with suspected CP based upon initial evaluation, including history and physical examination. Increased pericardial thickness (2 mm) is suggestive of but not diagnostic for CP. Absence of pericardial thickening does not exclude CP.

E/A: ratio of Doppler peak velocity of early diastolic inflow to to peak velocity of atrial diastolic inflow; IVC: inferior vena cava; HV: hepatic vein; e': early diastolic pulsed-wave tissue Doppler imaging at septal or lateral basal region; CP: constrictive pericarditis; CMR: cardiovascular magnetic resonance; CCT: cardiac computed tomography; RCM: restrictive cardiomyopathy.

* The HV expiratory diastolic flow reversal ratio is defined as the expiratory hepatic vein diastolic reversal velocity/forward velocity.

¶ Annulus reversus and strain reversus can be assessed only in the absence of a lateral wall motion abnormality. Annulus reversus is a ratio of lateral e' velocity to septal e' velocity <1. Strain reversus is a left ventricular lateral wall strain to left ventricular septal wall strain ratio <0.96.

Δ Cardiac catheterization is occasionally needed, particularly if CMR and/or CCT are unavailable or nondiagnostic.

Reference:

Welch TD, Ling LH, Espinosa RE, et al. Echocardiographic diagnosis of constrictive pericarditis: Mayo Clinic criteria. Circ Cardiovasc Imaging 2014; 7:526.

Adapted from:

Syed FF, Schaff HV, Oh JK. Constrictive pericarditis—a curable diastolic heart failure. Nat Rev Cardiol 2014; 11:530.
Welch TD. Pericardial disease. In: Practice of Clinical Echocardiography, 5th ed, Otto CM (Ed), Elsevier 2016.
Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2016; 29:277.
Alajaji W, Xu B, Sripariwuth A, et al. Noninvasive multimodality imaging for the diagnosis of constrictive pericarditis. Circ Cardiovasc Imaging 2018; 11:e007878.

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An approach to diagnosis of constrictive pericarditis