Comparison of new Doppler echocardiographic methods to differentiate constrictive pericardial heart disease and restrictive cardiomyopathy

This study assesses how the newer modalities of tissue Doppler echocardiogr aphy and color M-mode flow propagation compare with respiratory variation o f Doppler flow in distinguishing between constrictive pericarditis and rest rictive cardiomyopathy. We studied 30 patients referred for further evaluat ion of diastolic function who had a diagnosis of constrictive pericarditis or restrictive cardiomyopathy established by diagnostic tests, including cl inical assessment, magnetic resonance imaging, cardiac catheterization, end omyocardial biopsy, and surgical findings. Nineteen patients had constricti ve pericarditis and 11 had restrictive cardiomyopathy. We performed 2-dimen sional transesophageal echocardiography combined with pulsed-wave Doppler o f the pulmonary veins and mitral inflow with respiratory monitoring, tissue Doppler echocardiography of the lateral mitral annulus, and color M-mode f low propagation of left ventricular filling. Respiratory variation of the m itral inflow peak early (peak E) velocity of greater than or equal to 10% p redicted constrictive pericarditis with 84% sensitivity and 91% specificity and variation in the pulmonary venous peak diastolic (peak D) flow velocit y of greater than or equal to 18% distinguished constriction with 79% sensi tivity and 91% specificity. Using tissue Doppler echocardiography, a peak e arly velocity of longitudinal expansion (peak E-a) of greater than or equal to8.0 cm/s differentiated patients with constriction from restriction with 89% sensitivity and 100% specificity A slope of greater than or equal to 1 00 cm/s for the first aliasing contour in color M-mode flow propagation pre dicted patients with constriction with 74% sensitivity and 91% specificity. Thus, the newer methods of tissue Doppler echocardiography and color M-mod e flow propagation are equivalent and complimentary with Doppler respirator y variation in distinguishing between constrictive pericarditis and restric tive cardiomyopathy. The additive role of the new methods needs to be estab lished in difficult cases of constrictive pericarditis where respiratory va riation may be absent or decreased. (C) 2001 by Excerpta Medica, Inc.