Echocardiographic diagnosis of constrictive pericarditis Mayo Clinic criteria

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.