ECHO 2013 / Constriction or Cardiomyopathy Paradoxical Diastolic Heart Failure
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Normal vs Abnormal Heart
Relaxation and Suction
Normal > 10 cm/s
Medial 13 cm/s
Medial 3 cm/s
©2011 MFMER |
slide-61 ©2012 MFMER | 3225607-61
Constriction
Abnormal Septal Motion
Consider Constriction if a patient with CHF has normal EF and abnormal septal motion
©2012 MFMER
©2011 MFMER |
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Hepatic Vein Diastolic Flow Reversal
Myocardial vs Pericardial
Myocardial |
Pericardial |
Inspirational |
Expiratory |
reversal |
reversal |
©2011 MFMER |
slide-63 ©2012 MFMER | 3225607-63
Summary History to Diagnosis
Symptoms Anatomy
Clinician |
Cath |
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Patient |
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CT |
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MRI |
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Echo |
Function
Pressures
Echo
Cath
Nuclear
MRI
CT
©2012 MFMER | 3225607-64
Hepatic vein Doppler
©2011 MFMER |
slide-65 ©2012 MFMER | 3225607-65
Restriction vs Constriction
Similar Hemodynamics
RCM |
Constriction |
Equalization of Diastolic Pressures
Dip and Plateau / Square Root
©2012 MFMER | 3225607-66
Myocardial Relaxation
Decreased in All Myocardial Diseases
Early diastolic mitral annulus velocity (e’)
is Non-invasive tau |
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©2011 |
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CP1254003MFMER-8 | |
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©2012 MFMER | 3225607-67 |
Echo Diagnostic Criteria for Constriction Sensitivity and Specificity
Variable |
Sensitivity |
Specificity |
Positive |
Negative |
|
(%) |
(%) |
PV(%) |
PV(%) |
|
|
|
|
|
Septal shift vs. no septal shift |
92 |
69 |
92 |
71 |
Percent change in mitral E |
84 |
73 |
92 |
55 |
velocity >= 14.6% |
|
|
|
|
Medial e’ velocity >= 9 cm/s |
83 |
81 |
94 |
57 |
Medial e’/Lateral e’ >= 0.91 |
75 |
85 |
95 |
50 |
HV diastolic reversal/velocity |
76 |
88 |
96 |
49 |
in expiration >= 0.79 |
|
|
|
|
|
|
|
|
|
IVC max diameter > 2.1 cm |
79 |
28 |
80 |
27 |
and % change < 50% |
|
|
|
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Terrence Welch et al. Accepted to ACC 2013
©2012 MFMER | 3225607-68
Case #3
A 71 year old man presents with progressively worsening of dyspnea. Referred for pericardiectomy. Physical examination demonstrated marked elevation of JVP and S3. Echocardiography, CT, and hemodynamic cardiac catheterization provided following data.
©2012 MFMER | 3225607-69
Constrictive Pericarditis in the Modern Era
Novel Criteria for Diagnosis in the Cardiac Cath Laboratory (Talreja, Nishimura, Oh, Holmes. Jan. 2008 JACC)
Discordant change
Constriction
Restriction(RMC)
Concordant change