Annulus paradoxus - Transmitral flow velocity to mitral annular velocity ratio is inversely proportional to pulmonary capillary wedge pressure in patients with constrictive pericarditis

Background-The early diastolic velocity of the mitral annulus (E') is reduc ed in patients with diastolic dysfunction and increased filling pressures. Because transmittal inflow early velocity (E) increases progressively with higher filling pressures, E/E' has been shown to have a strong positive rel ationship with pulmonary capillary wedge pressure (PCWP) and left ventricul ar end-diastolic pressure. However, previous studies have primarily involve d patients without a pericardial abnormality. In constrictive pericarditis (CP), E' is not reduced, despite increased filling pressures. This study ev aluated the relationship between E/E' and PCWP in patients with CP. Methods and Results-We studied 10 patients (8 men; mean age, 64 +/- 7 years ) with surgically confirmed CP. Doppler echocardiography was performed to m easure early and late diastolic transmittal flow velocities. Tissue Doppler echocardiography was performed to measure E'. PCWP was measured with right heart catheterization. All patients were in sinus rhythm. Mean E and E' we re 91 +/- 15 cm/s and 11 +/- 4 cm/s, respectively. Mean PCWP was 25 +/- 6 m m Hg. E' was positively correlated with PCW (r = 0.69, P = 0.027). There wa s a significant inverse correlation between E/E' and PCWP (r = 0.74, P = 0. 014). Despite high left ventricular filling pressures, E/E' (mean, 9 +/- 4) was <15 in all but 1 patient. Conclusions-Paradoxical to the positive correlation between E/E' and PCWP i n patients with myocardial disease, an inverse relationship was found in pa tients with CP.