Author + information
- Received April 14, 1995
- Revision received August 9, 1995
- Accepted August 17, 1995
- Published online January 1, 1996.
- Mario J. Garcia, MDa,
- Leonardo Rodriguez, MD*,
- Miguel Ares, MD*,
- Brian P. Griffin, MD*,
- James D. Thomas, MD, FACC* and
- Allan L. Klein, MD, FACC*,**
- ↵**Address for correspondence: Allan L. Klein, MD, The Cleveland Clinic Foundation, Department of Cardiology, Desk F15, 9500 Euclid Avenue, Cleveland, Ohio 44195.
Objectives. We sought to determine the utility of left ventricular expansion velocities in differentiating constrictive pericarditis from restrictive cardiomyopathy.
Background. Several studies have shown that left ventricular diastolic expansion is influenced by the elastic recoil forces of the myocardium. These forces are affected by intrinsic myocardial disease but should be preserved when diastole is impaired as a result of extrinsic causes.
Methods. Using Doppler tissue imaging, we measured peak early velocity of longitudinal axis expansion (Ea) in 8 patients with constrictive pericarditis, 7 patients with restriction and 15 normal volunteers. Transmitral early (E) and late (A) Doppler flow velocities, left ventricular systolic and diastolic volumes, ejection fraction and mitral annular M-mode displacement were also compared between the groups.
Results. The Eavalue was significantly higher in normal subjects (14.5 ± 4.7 cm/s [mean ±SD]) and in patients with constriction (14.8 ± 4.8 cm/s) than in those with restriction (5.1 ± 1.4 cm/s, p < 0.001 constriction vs. restriction). There was weak correlation between Eaand the extent of annular displacement (r = 0.55, p = 0.004) and the E/A ratio (r = 0.44, p = 0.03). There was no correlation between Eaand E (r = 0.33, p = 0.07) or ejection fraction (r = 0.21, p = 0.26). By multivariate analysis, Eawas the best variable for differentiating constriction from restriction.
Conclusions. Our study indicates that longitudinal axis expansion velocities are markedly reduced in patients with restrictive cardiomyopathy. The poor correlation found with transvalvular flow velocities suggests that Eamay be relatively preload independent. The measurement of longitudinal axis expansion velocities provides a clinically useful distinction between constrictive pericarditis and restrictive cardiomyopathy and may prove to be valuable in the study of diastolic function.
This study was supported in part by Grant-in-Aid 93-013880 from the American Heart Association, Dallas, Texas (Dr. Thomas) and was presented in part at the 67th Scientific Sessions of the American Heart Association, Dallas, Texas, November 1994. Dr. Ares was supported by a scholarship from Fondo de Investigaciones Sanitaras, Madrid, Spain.
- Received April 14, 1995.
- Revision received August 9, 1995.
- Accepted August 17, 1995.
- American College of Cardiology