Preload reduction to unmask the characteristic Doppler features of constrictive pericarditis

A new observation

Jae Kuen Oh, A. Jamil Tajik, Christopher P. Appleton, Liv K. Hatle, Rick A. Nishimura, James B. Seward

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

Background: Respiratory variation of ≤25% in mitral E velocity is a characteristic Doppler echocardiographic feature in constrictive pericarditis. However, a subset of patients with constriction do not exhibit the typical respiratory change, most likely because of marked increase in the left atrial pressure, and preload reduction may unmask the respiratory variation. Methods and Results: In 12 patients with surgically confirmed constrictive pericarditis who had <25% respiratory variation in mitral E velocity during an initial precoperative examination, the Doppler study was repeated after an attempt to decrease left ventricular filling pressure. At baseline, mean mitral E velocity was similar after inspiration and expiration (0.81 ± 0.24 and 0.84±0.21 m/s, respectively). On repeat Doppler examination, with the patient in a head-up tilt or sitting position, the decrease in mitral E velocity with inspiration (0.61 ± 0.13 m/s) was significant (P<.004), whereas it did not change significantly with expiration. The mean percent respiratory change in E velocity was 5±7% at baseline and 32±28% with preload reduction. Eight (75%) of the 12 patients developed respiratory variation of ≤25%. Conclusions: When the respiratory variation in Doppler mitral E velocity is blunted or absent during the evaluation of suspected constrictive pericarditis, repeat Doppler recording of mitral flow velocities after maneuvers to decrease preload is recommended to unmask the characteristic respiratory variation in mitral E velocity.

Original languageEnglish (US)
Pages (from-to)796-799
Number of pages4
JournalCirculation
Volume95
Issue number4
StatePublished - 1997

Fingerprint

Constrictive Pericarditis
Observation
Atrial Pressure
Ventricular Pressure
Posture
Constriction
Head

Keywords

  • blood flow
  • echocardiography pericarditis
  • respiration

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Oh, J. K., Jamil Tajik, A., Appleton, C. P., Hatle, L. K., Nishimura, R. A., & Seward, J. B. (1997). Preload reduction to unmask the characteristic Doppler features of constrictive pericarditis: A new observation. Circulation, 95(4), 796-799.

Preload reduction to unmask the characteristic Doppler features of constrictive pericarditis : A new observation. / Oh, Jae Kuen; Jamil Tajik, A.; Appleton, Christopher P.; Hatle, Liv K.; Nishimura, Rick A.; Seward, James B.

In: Circulation, Vol. 95, No. 4, 1997, p. 796-799.

Research output: Contribution to journalArticle

Oh, JK, Jamil Tajik, A, Appleton, CP, Hatle, LK, Nishimura, RA & Seward, JB 1997, 'Preload reduction to unmask the characteristic Doppler features of constrictive pericarditis: A new observation', Circulation, vol. 95, no. 4, pp. 796-799.
Oh JK, Jamil Tajik A, Appleton CP, Hatle LK, Nishimura RA, Seward JB. Preload reduction to unmask the characteristic Doppler features of constrictive pericarditis: A new observation. Circulation. 1997;95(4):796-799.
Oh, Jae Kuen ; Jamil Tajik, A. ; Appleton, Christopher P. ; Hatle, Liv K. ; Nishimura, Rick A. ; Seward, James B. / Preload reduction to unmask the characteristic Doppler features of constrictive pericarditis : A new observation. In: Circulation. 1997 ; Vol. 95, No. 4. pp. 796-799.
@article{f24385f96aaf46c0a3039e1581badfb6,
title = "Preload reduction to unmask the characteristic Doppler features of constrictive pericarditis: A new observation",
abstract = "Background: Respiratory variation of ≤25{\%} in mitral E velocity is a characteristic Doppler echocardiographic feature in constrictive pericarditis. However, a subset of patients with constriction do not exhibit the typical respiratory change, most likely because of marked increase in the left atrial pressure, and preload reduction may unmask the respiratory variation. Methods and Results: In 12 patients with surgically confirmed constrictive pericarditis who had <25{\%} respiratory variation in mitral E velocity during an initial precoperative examination, the Doppler study was repeated after an attempt to decrease left ventricular filling pressure. At baseline, mean mitral E velocity was similar after inspiration and expiration (0.81 ± 0.24 and 0.84±0.21 m/s, respectively). On repeat Doppler examination, with the patient in a head-up tilt or sitting position, the decrease in mitral E velocity with inspiration (0.61 ± 0.13 m/s) was significant (P<.004), whereas it did not change significantly with expiration. The mean percent respiratory change in E velocity was 5±7{\%} at baseline and 32±28{\%} with preload reduction. Eight (75{\%}) of the 12 patients developed respiratory variation of ≤25{\%}. Conclusions: When the respiratory variation in Doppler mitral E velocity is blunted or absent during the evaluation of suspected constrictive pericarditis, repeat Doppler recording of mitral flow velocities after maneuvers to decrease preload is recommended to unmask the characteristic respiratory variation in mitral E velocity.",
keywords = "blood flow, echocardiography pericarditis, respiration",
author = "Oh, {Jae Kuen} and {Jamil Tajik}, A. and Appleton, {Christopher P.} and Hatle, {Liv K.} and Nishimura, {Rick A.} and Seward, {James B.}",
year = "1997",
language = "English (US)",
volume = "95",
pages = "796--799",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Preload reduction to unmask the characteristic Doppler features of constrictive pericarditis

T2 - A new observation

AU - Oh, Jae Kuen

AU - Jamil Tajik, A.

AU - Appleton, Christopher P.

AU - Hatle, Liv K.

AU - Nishimura, Rick A.

AU - Seward, James B.

PY - 1997

Y1 - 1997

N2 - Background: Respiratory variation of ≤25% in mitral E velocity is a characteristic Doppler echocardiographic feature in constrictive pericarditis. However, a subset of patients with constriction do not exhibit the typical respiratory change, most likely because of marked increase in the left atrial pressure, and preload reduction may unmask the respiratory variation. Methods and Results: In 12 patients with surgically confirmed constrictive pericarditis who had <25% respiratory variation in mitral E velocity during an initial precoperative examination, the Doppler study was repeated after an attempt to decrease left ventricular filling pressure. At baseline, mean mitral E velocity was similar after inspiration and expiration (0.81 ± 0.24 and 0.84±0.21 m/s, respectively). On repeat Doppler examination, with the patient in a head-up tilt or sitting position, the decrease in mitral E velocity with inspiration (0.61 ± 0.13 m/s) was significant (P<.004), whereas it did not change significantly with expiration. The mean percent respiratory change in E velocity was 5±7% at baseline and 32±28% with preload reduction. Eight (75%) of the 12 patients developed respiratory variation of ≤25%. Conclusions: When the respiratory variation in Doppler mitral E velocity is blunted or absent during the evaluation of suspected constrictive pericarditis, repeat Doppler recording of mitral flow velocities after maneuvers to decrease preload is recommended to unmask the characteristic respiratory variation in mitral E velocity.

AB - Background: Respiratory variation of ≤25% in mitral E velocity is a characteristic Doppler echocardiographic feature in constrictive pericarditis. However, a subset of patients with constriction do not exhibit the typical respiratory change, most likely because of marked increase in the left atrial pressure, and preload reduction may unmask the respiratory variation. Methods and Results: In 12 patients with surgically confirmed constrictive pericarditis who had <25% respiratory variation in mitral E velocity during an initial precoperative examination, the Doppler study was repeated after an attempt to decrease left ventricular filling pressure. At baseline, mean mitral E velocity was similar after inspiration and expiration (0.81 ± 0.24 and 0.84±0.21 m/s, respectively). On repeat Doppler examination, with the patient in a head-up tilt or sitting position, the decrease in mitral E velocity with inspiration (0.61 ± 0.13 m/s) was significant (P<.004), whereas it did not change significantly with expiration. The mean percent respiratory change in E velocity was 5±7% at baseline and 32±28% with preload reduction. Eight (75%) of the 12 patients developed respiratory variation of ≤25%. Conclusions: When the respiratory variation in Doppler mitral E velocity is blunted or absent during the evaluation of suspected constrictive pericarditis, repeat Doppler recording of mitral flow velocities after maneuvers to decrease preload is recommended to unmask the characteristic respiratory variation in mitral E velocity.

KW - blood flow

KW - echocardiography pericarditis

KW - respiration

UR - http://www.scopus.com/inward/record.url?scp=16944364327&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=16944364327&partnerID=8YFLogxK

M3 - Article

VL - 95

SP - 796

EP - 799

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 4

ER -