ECHO 2013 / Constriction or Cardiomyopathy Paradoxical Diastolic Heart Failure
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Constriction or Cardiomyopathy?
Paradoxical Diastolic Heart Failure
Jae K. Oh, MD
Oh.jae@mayo.edu
State of the Art Echo in NYC
April 4th , 2013
There is nothing to disclose for this presentation.
©2012 MFMER | 3225607-1
Unique Features in
Constrictive Pericarditis
Liv Hatle, MD
•Dissociation between intracavitary (LVEDP) and intrathoracic (PCWP) pressures
•Exaggerated ventricular interaction
Circulation, 1989 ©2011
MFMER |
slide-2 ©2012 MFMER | 3225607-2
An Illustrative Case
65 yo man with Pleural Effusion
•CABG 9 months ago
•Increasing dyspnea 6 weeks after the surgery
•Underwent 7 thoracenteses, chest tube and pleurodesis
•Referred to our pulmonary section
©2012 MFMER | 3225607-3
Myocardial vs Pericardial
Paradoxical Diastolic Heart Failure
No paradoxical Pulse |
Paradoxical |
|
|
No variation |
Dias filling |
Variation |
|
Expiration |
HV reversal |
Inspiration |
|
Normal or |
Medial E’ |
Paradoxical |
|
Abnormal |
Strain |
Normal |
|
Elevated |
BNP |
Not elevated |
|
Concordant |
LV/RV SP |
Discordant |
©2012 MFMER | 3225607-4 |
|
|
|
CP983059-3 |
Hemodynamics of Myocardial Disease
80
|
LV |
40 |
PCW |
|
Inspiration Expiration Inspiration
0
Hatle et al. Circ 1989
©2011
MFMER |
CP1105201-1 slide-5
©2012 MFMER | 3225607-5
Constrictive Pericarditis
Unique Hemodynamics
E
E
Mitral Inflow vs Cath
1.Dissociation between intrathoracic and intracardiac pressures
2. Interventricular Dependence
CP992397-39
©2012 MFMER | 3225607-6
Hemodynamics in Constriction
Intracardiac pressure < intrathoracic pressure
Interventricular dependence
CP1051850-19
©2012 MFMER | 3225607-7
Constriction
Abnormal septal motion
Interventricular Dependence
“Consider constriction if there is septal motion abnormality in patients with HF and preserved EF (HFpEF)”
Expir
Inspir
©2012 MFMER | 3225607-8
Mitral Inflow
Hepatic vein
Insp Exp
Tricuspid
Echo Dx of Constriction
1989-1997
1.Abnormal Septal Motion
2.Restrictive Mitral Inflow with Respiratory Variation > 25%
3.Hepatic Vein Diastolic Flow Reversals with Expiration
Hatle, Appleton Circ 1989 , Oh, Hatle JACC 1994 , Oh, Circ 1997
©2012 MFMER | 3225607-9
Evaluation of Diastolic Function
Mitral Inflow and Annulus Velocity
Normal |
Ab Relax |
Pseudo |
Restrictive |
|
Grade 1 |
Grade 2 |
Grade 3 |
Mitral flow
Mitral annulus velocity
Preload dependent
Preload independent
Sohn et al: JACC, 1997
©2011
CP1254003MFMER-30 |
slide-10 ©2012 MFMER | 3225607-10