Echocardiographic diagnosis of constrictive pericarditis Mayo Clinic criteria

Terrence D. Welch, Lieng H. Ling, Raul Emilio Espinosa, Nandan S. Anavekar, Heather J. Wiste, Brian D. Lahr, Hartzell V Schaff, Jae Kuen Oh

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

Background-Constrictive pericarditis is a potentially reversible cause of heart failure that may be diffcult to differentiate from restrictive myocardial disease and severe tricuspid regurgitation. Echocardiography provides an important opportunity to evaluate for constrictive pericarditis, and defnite diagnostic criteria are needed. Methods and Results-Patients with surgically confrmed constrictive pericarditis (n=130) at Mayo Clinic (2008-2010) were compared with patients (n=36) diagnosed with restrictive myocardial disease or severe tricuspid regurgitation after constrictive pericarditis was considered but ruled out. Comprehensive echocardiograms were reviewed in blinded fashion. Five principal echocardiographic variables were selected based on prior studies and potential for clinical use: (1) respiration-related ventricular septal shift, (2) variation in mitral infow E velocity, (3) medial mitral annular e' velocity, (4) ratio of medial mitral annular e' to lateral e', and (5) hepatic vein expiratory diastolic reversal ratio. All 5 principal variables differed signifcantly between the groups. In patients with atrial fbrillation or futter (n=29), all but mitral infow velocity remained signifcantly different. Three variables were independently associated with constrictive pericarditis: (1) ventricular septal shift, (2) medial mitral e', and (3) hepatic vein expiratory diastolic reversal ratio. The presence of ventricular septal shift in combination with either medial e'≥9 cm/s or hepatic vein expiratory diastolic reversal ratio ≥0.79 corresponded to a desirable combination of sensitivity (87%) and specifcity (91%). The specifcity increased to 97% when all 3 factors were present, but the sensitivity decreased to 64%. Conclusions-Echocardiography allows differentiation of constrictive pericarditis from restrictive myocardial disease and severe tricuspid regurgitation. Respiration-related ventricular septal shift, preserved or increased medial mitral annular e' velocity, and prominent hepatic vein expiratory diastolic fow reversals are independently associated with the diagnosis of constrictive pericarditis.

Original languageEnglish (US)
Pages (from-to)526-534
Number of pages9
JournalCirculation: Cardiovascular Imaging
Volume7
Issue number3
DOIs
StatePublished - 2014

Fingerprint

Constrictive Pericarditis
Hepatic Veins
Tricuspid Valve Insufficiency
Cardiomyopathies
Echocardiography
Respiration
Heart Failure

Keywords

  • Echocardiography
  • Pericarditis, constrictive

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Echocardiographic diagnosis of constrictive pericarditis Mayo Clinic criteria. / Welch, Terrence D.; Ling, Lieng H.; Espinosa, Raul Emilio; Anavekar, Nandan S.; Wiste, Heather J.; Lahr, Brian D.; Schaff, Hartzell V; Oh, Jae Kuen.

In: Circulation: Cardiovascular Imaging, Vol. 7, No. 3, 2014, p. 526-534.

Research output: Contribution to journalArticle

Welch, Terrence D. ; Ling, Lieng H. ; Espinosa, Raul Emilio ; Anavekar, Nandan S. ; Wiste, Heather J. ; Lahr, Brian D. ; Schaff, Hartzell V ; Oh, Jae Kuen. / Echocardiographic diagnosis of constrictive pericarditis Mayo Clinic criteria. In: Circulation: Cardiovascular Imaging. 2014 ; Vol. 7, No. 3. pp. 526-534.
@article{617d5ef94d134deaa37aadb3561c71b1,
title = "Echocardiographic diagnosis of constrictive pericarditis Mayo Clinic criteria",
abstract = "Background-Constrictive pericarditis is a potentially reversible cause of heart failure that may be diffcult to differentiate from restrictive myocardial disease and severe tricuspid regurgitation. Echocardiography provides an important opportunity to evaluate for constrictive pericarditis, and defnite diagnostic criteria are needed. Methods and Results-Patients with surgically confrmed constrictive pericarditis (n=130) at Mayo Clinic (2008-2010) were compared with patients (n=36) diagnosed with restrictive myocardial disease or severe tricuspid regurgitation after constrictive pericarditis was considered but ruled out. Comprehensive echocardiograms were reviewed in blinded fashion. Five principal echocardiographic variables were selected based on prior studies and potential for clinical use: (1) respiration-related ventricular septal shift, (2) variation in mitral infow E velocity, (3) medial mitral annular e' velocity, (4) ratio of medial mitral annular e' to lateral e', and (5) hepatic vein expiratory diastolic reversal ratio. All 5 principal variables differed signifcantly between the groups. In patients with atrial fbrillation or futter (n=29), all but mitral infow velocity remained signifcantly different. Three variables were independently associated with constrictive pericarditis: (1) ventricular septal shift, (2) medial mitral e', and (3) hepatic vein expiratory diastolic reversal ratio. The presence of ventricular septal shift in combination with either medial e'≥9 cm/s or hepatic vein expiratory diastolic reversal ratio ≥0.79 corresponded to a desirable combination of sensitivity (87{\%}) and specifcity (91{\%}). The specifcity increased to 97{\%} when all 3 factors were present, but the sensitivity decreased to 64{\%}. Conclusions-Echocardiography allows differentiation of constrictive pericarditis from restrictive myocardial disease and severe tricuspid regurgitation. Respiration-related ventricular septal shift, preserved or increased medial mitral annular e' velocity, and prominent hepatic vein expiratory diastolic fow reversals are independently associated with the diagnosis of constrictive pericarditis.",
keywords = "Echocardiography, Pericarditis, constrictive",
author = "Welch, {Terrence D.} and Ling, {Lieng H.} and Espinosa, {Raul Emilio} and Anavekar, {Nandan S.} and Wiste, {Heather J.} and Lahr, {Brian D.} and Schaff, {Hartzell V} and Oh, {Jae Kuen}",
year = "2014",
doi = "10.1161/CIRCIMAGING.113.001613",
language = "English (US)",
volume = "7",
pages = "526--534",
journal = "Circulation: Cardiovascular Imaging",
issn = "1941-9651",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Echocardiographic diagnosis of constrictive pericarditis Mayo Clinic criteria

AU - Welch, Terrence D.

AU - Ling, Lieng H.

AU - Espinosa, Raul Emilio

AU - Anavekar, Nandan S.

AU - Wiste, Heather J.

AU - Lahr, Brian D.

AU - Schaff, Hartzell V

AU - Oh, Jae Kuen

PY - 2014

Y1 - 2014

N2 - Background-Constrictive pericarditis is a potentially reversible cause of heart failure that may be diffcult to differentiate from restrictive myocardial disease and severe tricuspid regurgitation. Echocardiography provides an important opportunity to evaluate for constrictive pericarditis, and defnite diagnostic criteria are needed. Methods and Results-Patients with surgically confrmed constrictive pericarditis (n=130) at Mayo Clinic (2008-2010) were compared with patients (n=36) diagnosed with restrictive myocardial disease or severe tricuspid regurgitation after constrictive pericarditis was considered but ruled out. Comprehensive echocardiograms were reviewed in blinded fashion. Five principal echocardiographic variables were selected based on prior studies and potential for clinical use: (1) respiration-related ventricular septal shift, (2) variation in mitral infow E velocity, (3) medial mitral annular e' velocity, (4) ratio of medial mitral annular e' to lateral e', and (5) hepatic vein expiratory diastolic reversal ratio. All 5 principal variables differed signifcantly between the groups. In patients with atrial fbrillation or futter (n=29), all but mitral infow velocity remained signifcantly different. Three variables were independently associated with constrictive pericarditis: (1) ventricular septal shift, (2) medial mitral e', and (3) hepatic vein expiratory diastolic reversal ratio. The presence of ventricular septal shift in combination with either medial e'≥9 cm/s or hepatic vein expiratory diastolic reversal ratio ≥0.79 corresponded to a desirable combination of sensitivity (87%) and specifcity (91%). The specifcity increased to 97% when all 3 factors were present, but the sensitivity decreased to 64%. Conclusions-Echocardiography allows differentiation of constrictive pericarditis from restrictive myocardial disease and severe tricuspid regurgitation. Respiration-related ventricular septal shift, preserved or increased medial mitral annular e' velocity, and prominent hepatic vein expiratory diastolic fow reversals are independently associated with the diagnosis of constrictive pericarditis.

AB - Background-Constrictive pericarditis is a potentially reversible cause of heart failure that may be diffcult to differentiate from restrictive myocardial disease and severe tricuspid regurgitation. Echocardiography provides an important opportunity to evaluate for constrictive pericarditis, and defnite diagnostic criteria are needed. Methods and Results-Patients with surgically confrmed constrictive pericarditis (n=130) at Mayo Clinic (2008-2010) were compared with patients (n=36) diagnosed with restrictive myocardial disease or severe tricuspid regurgitation after constrictive pericarditis was considered but ruled out. Comprehensive echocardiograms were reviewed in blinded fashion. Five principal echocardiographic variables were selected based on prior studies and potential for clinical use: (1) respiration-related ventricular septal shift, (2) variation in mitral infow E velocity, (3) medial mitral annular e' velocity, (4) ratio of medial mitral annular e' to lateral e', and (5) hepatic vein expiratory diastolic reversal ratio. All 5 principal variables differed signifcantly between the groups. In patients with atrial fbrillation or futter (n=29), all but mitral infow velocity remained signifcantly different. Three variables were independently associated with constrictive pericarditis: (1) ventricular septal shift, (2) medial mitral e', and (3) hepatic vein expiratory diastolic reversal ratio. The presence of ventricular septal shift in combination with either medial e'≥9 cm/s or hepatic vein expiratory diastolic reversal ratio ≥0.79 corresponded to a desirable combination of sensitivity (87%) and specifcity (91%). The specifcity increased to 97% when all 3 factors were present, but the sensitivity decreased to 64%. Conclusions-Echocardiography allows differentiation of constrictive pericarditis from restrictive myocardial disease and severe tricuspid regurgitation. Respiration-related ventricular septal shift, preserved or increased medial mitral annular e' velocity, and prominent hepatic vein expiratory diastolic fow reversals are independently associated with the diagnosis of constrictive pericarditis.

KW - Echocardiography

KW - Pericarditis, constrictive

UR - http://www.scopus.com/inward/record.url?scp=84904137291&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84904137291&partnerID=8YFLogxK

U2 - 10.1161/CIRCIMAGING.113.001613

DO - 10.1161/CIRCIMAGING.113.001613

M3 - Article

C2 - 24633783

AN - SCOPUS:84904137291

VL - 7

SP - 526

EP - 534

JO - Circulation: Cardiovascular Imaging

JF - Circulation: Cardiovascular Imaging

SN - 1941-9651

IS - 3

ER -