Prognostic importance of mitral e' velocity in constrictive pericarditis

Jeong Hoon Yang, William R. Miranda, Rick A. Nishimura, Kevin L. Greason, Hartzell V. Schaff, Jae K. Oh

Research output: Contribution to journalArticlepeer-review

Abstract

AIMS : Increased medial mitral annulus early diastolic velocity (e') plays an important role in the echocardiographic diagnosis of constrictive pericarditis (CP) and mitral e' velocity is also a marker of underlying myocardial disease. We assessed the prognostic implication of mitral e' for long-term mortality after pericardiectomy in patients with CP. METHODS AND RESULTS : We studied 104 surgically confirmed CP patients who underwent echocardiography and cardiac catheterization within 7 days between 2005 and 2013. Patients were classified as primary CP (n = 45) or mixed CP (n = 59) based on the clinical history of concomitant myocardial disease. On multivariable analysis, medial e' velocity and mean pulmonary artery pressure were independently associated with long-term mortality post-pericardiectomy. There were significant differences in survival rates among the groups divided by cut-off values of 9.0 cm/s and 29 mmHg for medial e' and mean pulmonary artery pressure, respectively (both P < 0.001). Ninety-two patients (88.5%) had elevated pulmonary artery wedge pressure (PAWP) (≥15 mmHg); there was no significant correlation between medial E/e' and PAWP (r = 0.002, P = 0.998). However, despite the similar PAWP between primary CP and mixed CP groups (21.6 ± 5.4 vs. 21.2 ± 5.8, P = 0.774), all primary CP individuals with elevated PAWP had medial E/e' <15 as opposed to 34 patients (57.6%) in the mixed CP group (P < 0.001). CONCLUSION : Increased mitral e' velocity is associated with better outcomes in patients with CP. A paradoxical distribution of the relationship between E/e' and PAWP is present in these patients but there is no direct inverse correlation between them.

Original languageEnglish (US)
Pages (from-to)357-364
Number of pages8
JournalEuropean heart journal cardiovascular Imaging
Volume22
Issue number3
DOIs
StatePublished - Feb 22 2021

Keywords

  • annulus paradoxus
  • constrictive pericarditis
  • filling pressure

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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