DOPPLER EVALUATION OF PATIENTS WITH CONSTRICTIVE PERICARDITIS - USE OF TRICUSPID REGURGITATION VELOCITY CURVES TO DETERMINE ENHANCED VENTRICULAR INTERACTION

Objectives: This study sought to examine the value of analyzing Dopple r echocardiographically derived tricuspid regurgitation signals during respiration in relation to the diagnosis of constrictive pericarditis . Background. A physiologic hallmark of constrictive pericarditis is e nhanced ventricular interdependence, which produces reciprocal changes in right and left ventricular filling and ejection dynamics during th e respiratory cycle. It was hypothesized that these changes could be d etected noninvasively by analyzing Doppler echocardiographically deriv ed tricuspid regurgitation signals and that this information could ass ist in noninvasively diagnosing constrictive pericarditis. Methods. Si multaneous Doppler echocardiography and catheterization studies of the right and left sides of the heart with high fidelity pressure manomet ers were performed in 5 patients with surgically confirmed constrictiv e pericarditis and 12 patients (control subjects) with heart failure d ue to other causes. Results. Changes observed in tricuspid regurgitati on Doppler echocardiographic variables from onset to peak inspiration in patients with constrictive pericarditis were significantly differen t from those in control subjects. Mean (+/-SD) percent change in maxim al tricuspid regurgitation velocity was 13% +/- 6% and -8% +/- 7% in t he constrictive pericarditis and control groups, respectively (p < 0.0 001); mean percent change in tricuspid regurgitation signal duration w as 18% +/- 2% and -2% +/- 7%, respectively (p < 0.0001); mean percent change in tricuspid regurgitation time velocity integral was 27% +/- 1 5% and -10% +/- 12%, respectively (p < 0.0001). Conclusions. Respirato ry changes in Doppler echocardiographically derived tricuspid regurgit ation peak velocity and velocity duration are increased in patients wi th constrictive pericarditis and may be helpful in diagnosing this con dition noninvasively.