DIFFERENTIATION OF CONSTRICTIVE PERICARDITIS FROM RESTRICTIVE CARDIOMYOPATHY BY DOPPLER TRANSESOPHAGEAL ECHOCARDIOGRAPHIC MEASUREMENTS OF RESPIRATORY VARIATIONS IN PULMONARY VENOUS FLOW

Objectives. The purpose of this study was to test the utility of measu ring respiratory variation in pulmonary venous flow by transesophageal echocardiography. Background. Respiratory variation of atrioventricul ar and central venous flow velocities by Doppler echocardiography has been used to differentiate constrictive pericarditis from restrictive cardiomyopathy. Methods. We performed pulsed wave Doppler transesophag eal echocardiography of the left or right pulmonary veins in 31 patien ts with diastolic dysfunction. Fourteen patients had constrictive peri carditis, and 17 had restrictive cardiomyopathy. We measured the pulmo nary venous peak systolic and diastolic flow velocities and the systol ic/diastolic flow ratio with transesophageal echocardiography during e xpiration and inspiration. The percent change in Doppler flow velocity from expiration to inspiration (%E) was calculated. Results. Pulmonar y venous peak systolic how in both inspiration and expiration was grea ter in constrictive pericarditis than in restrictive cardiomyopathy. T he %E for peak systolic flow tended to be higher in constrictive peric arditis (19% vs. 10%, p = 0.09). In contrast, pulmonary venous peak di astolic flow during inspiration was lower in constrictive pericarditis than in restrictive cardiomyopathy. The %E for peak diastolic flow wa s larger in constrictive pericarditis (29% vs. 16%, p = 0.008). The pu lmonary venous systolic/diastolic flow ratio was greater in constricti ve pericarditis in both inspiration and expiration. The combination of pulmonary venous systolic/diastolic flow ratio greater than or equal to 0.65 in inspiration and a %E for peak diastolic flow greater than o r equal to 40% correctly classified 86% of patients with constrictive pericarditis. Conclusions. The relatively larger pulmonary venous syst olic/diastolic flow ratio and greater respiratory variation in pulmona ry venous systolic, and especially diastolic, flow velocities by trans esophageal echocardiography can be useful signs in distinguishing cons trictive pericarditis from restrictive cardiomyopathy.