Comparison of mitral inflow and superior vena cava Doppler velocities in chronic obstructive pulmonary disease and constrictive pericarditis

Objective. This study was conducted to determine whether Doppler recording of superior vena cava flow velocities can differentiate chronic obstructive pulmonary disease from constrictive pericarditis in patients with a respir atory variation of greater than or equal to 25% in mitral inflow E velocity , Background. Although respiratory variation (greater than or equal to 25%) i n mitral E velocity is the main diagnostic criterion for constrictive peri carditis by Doppler echocardiography, it can also be present in chronic obs tructive pulmonary disease, Because the respiratory variation is due to inc reased change in intrathoracic pressure with respiration in chronic obstruc tive pulmonary disease, and to dissociation of intrathoracic-intracardiac p ressure changes in constriction, it was hypothesized that the Doppler how v elocity pattern in the superior vena cava (affected by intrathoracic pressu re) would be different in these two conditions. Methods. Pulsed-wave Doppler recording of mitral and superior vena cava Bow velocities in 20 patients with chronic obstructive pulmonary disease who h ad greater than or equal to 25% respiratory variation in mitral E-wave velo city were compared with those of 20 patients who had surgically proved cons trictive pericarditis, Results. Constrictive pericarditis and chronic obstructive pulmonary diseas e had similar respiratory variation in mitral E velocity (41% versus 46%), In the latter, the E/A ratio was lower (inspiration, 0.8 +/- 0.3 versus 1.5 +/- 0.7 [p < 0.0001]; expiration, 1.0 +/- 0.3 vs. 1.9 +/- 0.7 [p < 0.0001] ) and deceleration time longer (inspiration, 198 +/- 53 ms versus 137 +/- 3 2 ms; expiration, 225 +/- 43 ms vs, 161 +/- 33 ms [p < 0.0001]), Inspirator y superior vena cava systolic forward flow velocity was significantly highe r in chronic obstructive pulmonary disease (72.9 +/- 22.6 cm/s versus 36.2 +/- 9.3 cm/s, p < 0.0001), while expiratory systolic forward flow velocity was similar. Hence, there was a significantly greater respiratory variation in superior vena cava systolic forward Bow velocity in chronic obstructive pulmonary disease without an overlap with constrictive pericarditis (39.5 +/- 18.8 cm/s vs. 4.2 +/- 3.4 cm/s, p < 0.0001). Conclusions. Despite a similar respiratory variation in mitral E wave veloc ities, mitral inflow variables in chronic obstructive pulmonary disease are less restrictive compared with those in constrictive pericarditis, More im portantly, patients with chronic obstructive pulmonary disease show a marke d increase in inspiratory superior vena cava systolic forward flow velocity , which is not seen in patients with constrictive pericarditis. (J Am Coil Cardiol 1998;32:2043-8) (C) 1998 by the American College of Cardiology.