Author + information
- Terrence Welch,
- Lieng Ling,
- Nandan Anavekar,
- Heather Wiste,
- Brian Lahr,
- Hartzell Schaff,
- Raul Espinosa and
- Jae Oh
Constrictive pericarditis (CP) is a potentially reversible cause of heart failure that can pose a diagnostic challenge. This study provides the first blinded evaluation of the diagnostic accuracy of 5 modern echocardiographic parameters.
Mayo Clinic patients with surgically-confirmed CP (N=131) in 2008 through 2010 were identified and compared with a group (N=36) of patients with a different cause for right heart failure (restrictive cardiomyopathy or severe tricuspid regurgitation). All underwent a comprehensive echocardiogram with recording of respiration. Blinded review was performed.
There were statistically significant differences in 2-D and Doppler criteria between the two groups (Table). From a multivariable model, the presence of septal shift (p=0.003), increased medial e’ velocity (p=0.002), and prominent hepatic vein diastolic flow reversals (p=0.009) corresponded to a significantly increased likelihood of CP.
|Descriptive Statistics†||Test Performance|
|Variable||Constr. Pericarditis (N=131)||Other Diagnosis (N=36)||ROC Cutpoint||Sens.||Spec.||PPV||NPV|
|Ventricular septal shift||92%||31%*||−||92%||69%||92%||71%|
|% change in mitral E vel.||30.7 ± 20.3||13.7 ± 17.0*||≥ 14.6||84%||73%||92%||55%|
|Medial e' vel. (cm/sec)||12.9 ± 4.1||7.0 ± 2.6*||≥ 9.0||83%||81%||94%||57%|
|Medial e'/lateral e'||1.2 ± 0.4||0.8 ± 0.2*||≥ 0.91||75%||85%||95%||50%|
|HV exp. diast. reversal vel./forward vel.||1.4 ± 0.7||0.5 ± 0.4*||≥ 0.79||76%||88%||96%||49%|
Echocardiography provides a reliable means for differentiating CP from other causes of right heart failure in most patients. Demonstration of differential ventricular filling with respiration and ventricular interdependence along with preserved or increased septal mitral annular e’ velocity in patients with heart failure is strongly associated with the diagnosis of CP.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Pericardial Diseases
Abstract Category: 23. Pericardial/Myocardial Disease
Presentation Number: 1250-142
- 2013 American College of Cardiology Foundation