Mitral and tricuspid annular velocities in constrictive pericarditis and restrictive cardiomyopathy: Correlation with pericardial thickness on computed tomography

Objectives: The aims of this study were to: 1) compare early diastolic mitral annular velocity (E′) of septal annulus (SE′) with E′ of lateral mitral annulus (LE′) and right lateral tricuspid annulus (RE′) in patients with constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM); and 2) assess the relationship between pericardial thickness measured by computed tomography and lateral E′ velocity. Background: The SE′ velocity has been shown to be able to distinguish CP from RCM. However, tissue Doppler parameters of LE′ and RE′ velocities in patients with CP have not been comprehensively analyzed in comparison with SE′. Moreover, the impact of pericardial thickness on the lateral annulus velocity has not been assessed. Methods: Thirty-seven patients with CP, 35 patients with RCM, and 70 normal controls were evaluated with echocardiography including SE′, LE′, and RE′. In CP, the maximal pericardial thicknesses on both left and right ventricle were measured by computed tomography. Results: Mean LE′/SE′ (ratio between mitral LE′ and SE′) was 0.94 ± 0.17 and RE′/SE′ (ratio between tricuspid RE′ and mitral SE′) was 0.81 ± 0.26 in patients with CP, which were lower than those in normal controls (LE′/SE′ 1.36 ± 0.24; RE′/SE′ 1.30 ± 0.32; both p < 0.001) and patients with RCM (LE′/SE′ 1.35 ± 0.31; RE′/SE′ 1.96 ± 0.71; both p < 0.001). There was a significant inverse correlation between right pericardial thickness and RE′ (ρ = -0.489; p = 0.002) and similar trend between left pericardial thickness and LE′ (ρ = -0.284; p = 0.089). Conclusions: The ratio between lateral and septal E′ was significantly reduced in patients with CP compared with that in normal control patients and patients with RCM so that the reduced ratios of LE′/SE′ and RE′/SE′ appear to be a useful diagnostic parameter for CP. Moreover, reduced lateral E′ was correlated with the pericardial thickness on their respective sides.