title: Clinical features of mixed physiology of constriction and restriction: echocardiographic characteristics and clinical outcome.
abstract: OBJECTIVE
  An entity of patients with mixed physiology of constriction and restriction has been reported, however, the characteristics of these patients have not been well documented. We evaluated the clinical features and the outcome of these patients.
  
  
  RESULTS
  Study subjects consisted of 38 patients (57+/-14 years, 8 females, 30 males) who were diagnosed as having mixed physiology based on transthoracic and/or transesophageal echocardiography, MRI (or CT), cardiac catheterization, endomyocardial biopsy and/or surgical findings. Prior radiation therapy was the most frequent (50%) cause of mixed physiology followed by coronary artery bypass graft without prior radiation (24%) and heart transplantation (8%). The respiratory variation of peak early diastolic transmitral flow velocity by pulsed Doppler transesophageal echocardiography was 10.7% in patients with sinus rhythm and 18.1% in patients with atrial arrhythmia. Pericardial thickening was noted adjacent to the right-sided chambers in 19 patients, left-sided chambers in 10 patients, or both in 9 patients. All-cause 5-year mortality was 40% and unrelated to age, etiology, left ventricular systolic function and therapeutic course. There was a statistically significant difference (p<0.01) between the survival rates in patients with mixed physiology and in patients with pure constriction (n=125).
  
  
  CONCLUSIONS
  Due to the high mortality in this disease, discrimination of the entity from the patients with pure constriction is mandatory. Transthoracic and transesophageal echocardiography are helpful noninvasive techniques in the diagnosis and the understanding of the physiology of patients with mixed constriction and restriction.
authors.affiliation: Department of Digestive and Cardiovascular Medicine, The University of Tokushima Graduate School, Tokushima, Japan.
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Yamada
authors.forename: Tomotsugu
authors.initials: T
authors.lastname: Tabata
authors.forename: Sukaina J
authors.initials: SJ
authors.lastname: Jaffer
authors.forename: Jeanne K
authors.initials: JK
authors.lastname: Drinko
authors.forename: Susan E
authors.initials: SE
authors.lastname: Jasper
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lauer
authors.forename: James D
authors.initials: JD
authors.lastname: Thomas
authors.forename: Allan L
authors.initials: AL
authors.lastname: Klein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004452:Echocardiography; D018619:Echocardiography, Doppler, Pulsed; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010493:Pericarditis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D010496:Pericardium / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011446:Prospective Studies; D016896:Treatment Outcome