ECHO 2013 / Constriction or Cardiomyopathy Paradoxical Diastolic Heart Failure
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Mitral Annulus Tissue Velocity
Constriction vs Myocardial Disease
Medial
Sa
Aa
Ea
Lateral
Normal
“ Mitral medial annulus velocity > 7 cm/s suggests CP in pts with HF and normal EF”
©2012 MFMER | 3225607-11
Mitral Annular Velocity in Constriction
PCWP
(mm Hg)
32
30
28
26
24
22
20
18
16
2
r= - 0.78 P=0.023
20
15
Annulus Paradoxus
4 |
6 |
8 |
10 |
12 |
14 |
16 |
18 |
E/e’ at expiration
Ha and Oh et al. CirculationCP9705102001-54
©2012 MFMER | 3225607- 2
Mitral “Annulus Reversus”
Constrictive Pericarditis
lateral
“ Mitral medial annulus velocity
Lateralis higheris fr quentlythan, butlateralnot always,annulusless than
medial
velocity almost confirms CP in pts with HF and normal EF”
E’ = 9
medial
E’ = 14
©2012 MFMER | 3225607-13
Constriction in A. Fib
mitral annulus e’
“Annulus Reversus”
Lateral e’ = 7 cm/s Medial e’ = 10 cm/s ©2011
MFMER |
slide-14 ©2012 MFMER | 3225607-14
E’ velocity is inversely proportional to pericardial thickness in the AV groove
©2011
JACC CV Imaging June 2011 MFMER |
slide-15 ©2012 MFMER | 3225607-15
Speckle Strain in CP
©2012 MFMER | 3225607-16
Constrictive Pericarditis
Echocardiographic Diagnosis
|
Constrictive Pericarditis |
Other Diagnosis |
|
|
(N=131) |
(N=36) |
|
Variable |
Mean +/- SD or |
Mean +/- SD or % |
Adjusted P-value* |
|
% of patients |
of patients |
|
Ventricular |
92% |
31% |
<0.001 |
septal shift |
|
|
|
% change in |
30.7 +/- 20.3 |
13.7 +/- 17.0 |
<0.001 |
mitral E vel. |
|
|
|
Medial e’vel. |
12.9 +/- 4.1 |
7 +/- 2.6 |
<0.001 |
(cm/sec) |
|
|
|
Medial e’ / |
1.2 +/- 0.4 |
0.8 +/- 0.2 |
<0.001 |
lateral e’ |
|
|
|
HV exp. |
1.4 +/- 0.7 |
0.5 +/- 0.4 |
<0.001 |
diastolic |
|
|
|
reversal vel. / |
|
|
|
forward vel. |
|
|
|
|
Terrence Welch et al. Presented at ACC 2013 |
||
©2012 MFMER | 3225607-17
Mitral medial and lateral velocities
Pre and post pericardiectomy
Pre |
Post |
|
Medial |
||
|
||
14 cm/s |
9 cm/s |
Pre |
Post |
|
Lateral |
12 cm/s |
10 cm/s |
Veress and Oh et al Circ CV Imaging May 2011©20 2 MFMER | 3225607-18
Constrictive Pericarditis
Dx by Echocardiography 2013
•Ventricular septal shift
•Mitral inflow restrictive with or without respiratory variation
•Hepatic vein diastolic flow reversal with expiration
•Mitral medial annulus e’ velocity > 7 cm/s
•Annulus Paradoxus
•Mitral lateral e’ < medial e’ most of times
•Annulus Reversus
©2012 MFMER | 3225607-19
Constrictive Pericarditis
Clinical Mimicker
•69 year old man with severe tricuspid regurgitation
•50 year old man with liver transplant evaluation
•62 year old with PA systolic pressure of 90 mmHg
©2012 MFMER | 3225607-20