Value of dynamic respiratory changes in left and right ventricular pressures for the diagnosis of constrictive pericarditis.
BACKGROUND
Conventional cardiac catheterization criteria for the diagnosis of constrictive pericarditis (CP) rely on equalization of intracardiac pressures and have many recognized limitations. Recently, Doppler echocardiographic methods have been used to examine dynamic respiratory changes of increased ventricular interdependence and dissociation of intrathoracic and intracardiac pressures for the diagnosis of CP. These pathophysiological features may be best delineated by cardiac catheterization. Therefore, we studied the accuracy of these dynamic respiratory changes in left ventricular and right ventricular pressure for the diagnosis of CP at cardiac catheterization.


RESULTS
High-fidelity manometric catheters and respirometry were used to study 36 patients: 15 patients with surgically proven CP (group 1) and 21 patients with other causes of heart failure (group 2). Conventional cardiac catheterization variables used to establish the diagnosis of CP lacked sensitivity and specificity and failed to distinguish between these groups. However, the finding of discordance between right ventricular and left ventricular pressures during inspiration, a sign of increased ventricular interdependence, accurately distinguished patients in group 1 from those in group 2 (P < .05).


CONCLUSIONS
Examination of dynamic respiratory changes indicating increased ventricular interdependence may be helpful in the diagnosis of CP in the cardiac catheterization laboratory.
Hurrell
D G
DG
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
Nishimura
R A
RA
Higano
S T
ST
Appleton
C P
CP
Danielson
G K
GK
Holmes
D R
DR
Tajik
A J
AJ
D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D015331:Cohort Studies; D003937:Diagnosis, Differential; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010494:Pericarditis, Constrictive / Q000175:diagnosis* / Q000503:physiopathology; D011446:Prospective Studies; D012119:Respiration / Q000502:physiology*; D012129:Respiratory Function Tests; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D017725:Ventricular Pressure