Unique features of early diastolic mitral annulus velocity in constrictive pericarditis.
BACKGROUND
In most primary myocardial diseases, early diastolic mitral annulus velocity (E') decreases with disease progression. To our knowledge, constrictive pericarditis (CP) is the only condition without this phenomenon.


OBJECTIVE
This study was performed to evaluate the diagnostic and pathophysiologic role of mitral annulus velocity in patients with CP.


METHODS
In all, 17 patients with CP (9 men; mean age 46.5 +/- 14.3 years), 8 patients with cardiac tamponade (Tamp) (2 men; mean age 44.5 +/- 15.0 years), and age- and sex-matched control subjects for CP and Tamp were recruited for the study. Early mitral inflow velocity and E' were obtained while simultaneously recording respiration. In 8 patients with CP and in all patients with Tamp, these measurements were repeated after the relief of constrictive physiology or after pericardiocentesis.


RESULTS
In patients with CP, E' was significantly higher than it was for control subjects (12.9 +/- 3.0 cm/s vs 9.8 +/- 2.4 cm/s, P <.01). An E' of 2 cm/s higher than the predicted normal E' could differentiate patients with CP from control subjects with a sensitivity of 76% and specificity of 82%. In 12 of 17 patients (71%), inspiratory E' was higher than expiratory E'-the opposite of mitral inflow variation. In 8 patients, E' decreased significantly after the relief of constrictive physiology (13.8 +/- 2.5 cm/s vs 9.3 +/- 3.1 cm/s, P <.05). In contrast, E' in the Tamp group was significantly lower than in the control group (6.8 +/- 1.6 cm/s vs 10.2 +/- 2.5 cm/s, P <.01), did not show significant respiratory variation, and increased significantly after pericardiocentesis (6.8 +/- 1.6 cm/s vs 9.5 +/- 3.0 cm/s, P <.05).


CONCLUSIONS
E' is exaggerated in CP, which is helpful for diagnosis. The opposite phenomenon was noted in Tamp, a dissimilarity that might contribute to different hemodynamics.
Clinical Research Institute, Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, 20 Yongon-Dong, Chongno-Gu, Seoul 110-744, Korea. dwsohn@snu.ac.kr
Dae-Won
DW
Sohn
Yong-Jin
YJ
Kim
Hyo-Soo
HS
Kim
Ki-Bong
KB
Kim
Young-Bae
YB
Park
Yun-Shik
YS
Choi
D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology*; D002305:Cardiac Tamponade / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D003971:Diastole / Q000502:physiology; D004452:Echocardiography; D005260:Female; D006801:Humans; D007723:Korea; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D020519:Pericardiocentesis; D010494:Pericarditis, Constrictive / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors