DIFFERENTIATION OF CONSTRICTIVE PERICARDITIS FROM RESTRICTIVE CARDIOMYOPATHY - ASSESSMENT OF LEFT-VENTRICULAR DIASTOLIC VELOCITIES IN LONGITUDINAL AXIS BY DOPPLER TISSUE IMAGING

Objectives. We sought to determine the utility of left ventricular exp ansion velocities in differentiating constrictive pericarditis from re strictive cardiomyopathy. Background. Several studies have shown that left ventricular diastolic expansion is influenced by the elastic reco il forces of the myocardium, These forces are affected by intrinsic my ocardial disease but should be preserved when diastole is impaired as a result of extrinsic causes. Methods. Using Doppler tissue imaging, w e measured peak early velocity of longitudinal axis expansion (E(a)) i n 8 patients with constrictive pericarditis, 7 patients with restricti on and 15 normal volunteers, Transmitral early (E) and late (A) Dopple r flow velocities, left ventricular systolic and diastolic volumes, ej ection fraction and mitral annular M-mode displacement were also compa red between the groups. Results. The E(a) value was significantly high er in normal subjects (14.5 +/- 4.7 cm/s [mean +/- SD]) and in patient s with constriction (14.8 +/- 4.8 cm/s) than in those with restriction (5.1 +/- 1.4 cm/s, p < 0.001 constriction vs, restriction), There,vas weak correlation between E(a) and the extent of annular displacement (r = 0.55, p = 0.004) and the E/A ratio (r = 0.44, p = 0.03). There wa s no correlation between E(a) and E (r = 0.33, p = 0.07) or ejection f raction (r = 0.21, p = 0.26), By multivariate analysis, E(a) was the b est variable for differentiating constriction from restriction. Conclu sions. Our study indicates that longitudinal axis expansion velocities are markedly reduced in patients with restrictive cardiomyopathy, The poor correlation found with transvalvular how velocities suggests tha t E(a) may be relatively preload independent, The measurement of longi tudinal axis expansion velocities provides a clinically useful distinc tion between constrictive pericarditis and restrictive cardiomyopathy and may prove to be valuable in the study of diastolic function.