title: Diagnostic superiority of a combined assessment of the systolic and early diastolic mitral annular velocities by tissue Doppler imaging for the differentiation of restrictive cardiomyopathy from constrictive pericarditis.
abstract: OBJECTIVE
  Echocardiographic tissue Doppler imaging (TDI) has been proposed as diagnostic tool for the differentiation between constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM). The aim of this study was a comprehensive TDI analysis of systolic (S') and early diastolic (E') velocities of the septal and lateral mitral annulus (MA) in patients (pts) with severe diastolic dysfunction caused either by CP or RCM.
  
  
  RESULTS
  Sixty consecutive pts (34 men, mean age 61 +/- 11 years), 34 pts with proven CP and 26 pts with RCM due to cardiac amyloidosis, were included in the study. Forty-two of the 60 pts were in NYHA class III (70%). In pts with RCM systolic longitudinal velocity (S') was significantly decreased when compared to CP (septal MA 4.1 +/- 1.5 vs. 7.3 +/- 2.1 cm/s, p < 0.001; lateral MA 4.3 +/- 1.9 vs. 7.0 +/- 1.9 cm/s, p < 0.001). In addition, the RCM group showed a significantly decreased early diastolic longitudinal velocity (E'), both on the septal (4.1 +/- 1.6 vs. 12.9 +/- 4.9 cm/s, p < 0.001) and lateral side (4.8 +/- 1.9 vs. 11.3 +/- 3.7 cm/s; p < 0.001) of the mitral annulus. ROC analysis demonstrated an area under the curve of 0.889 (S' septal), 0.823 (S' lateral), 0.974 (E' septal), and 0.915 (E' lateral) for the differentiation of RCM and CP with a cutoff value of <8 cm/s. The combined use of an averaged S' cutoff value <8 cm/s as well as an E' cutoff value <8 at the lateral and septal MA demonstrated 93% sensitivity and 88% specificity for the diagnosis of RCM.
  
  
  CONCLUSIONS
  TDI provides a diagnostic superiority and an accurate discrimination between RCM and CP by using the combined cutoff value of <8 cm/s for S' and E' at both sides of the MA.
authors.affiliation: Department of Cardiology, Heart Center Northern-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany. Thomas.Butz@Marienhospital-Herne.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Butz
authors.forename: C
authors.initials: C
authors.lastname: Piper
authors.forename: C
authors.initials: C
authors.lastname: Langer
authors.forename: M
authors.initials: M
authors.lastname: Wiemer
authors.forename: T
authors.initials: T
authors.lastname: Kottmann
authors.forename: A
authors.initials: A
authors.lastname: Meissner
authors.forename: G
authors.initials: G
authors.lastname: Plehn
authors.forename: H J
authors.initials: HJ
authors.lastname: Trappe
authors.forename: D
authors.initials: D
authors.lastname: Horstkotte
authors.forename: L
authors.initials: L
authors.lastname: Faber
mesh_terms: D000368:Aged; D002313:Cardiomyopathy, Restrictive / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging; D010494:Pericarditis, Constrictive / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity