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Disparate patterns of left ventricular mechanics differentiate constrictive pericarditis from restrictive

Partho P Sengupta1, Vijay K Krishnamoorthy, Walter P Abhayaratna

  • 1Division of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona 85259, USA.

JACC. Cardiovascular Imaging
|April 10, 2009
PubMed

Insights

Constrictive pericarditis (CP) constrains left ventricular (LV) circumferential mechanics, while restrictive cardiomyopathy (RCM) affects longitudinal mechanics. These distinct patterns in LV deformation and diastolic recoil help differentiate between CP and RCM.

Area of Science:

  • Cardiology
  • Cardiac Mechanics
  • Diagnostic Imaging

Background:

  • Diastolic dysfunction in constrictive pericarditis (CP) stems from epicardial tethering and pericardial constraint.
  • Restrictive cardiomyopathy (RCM) is characterized by subendocardial dysfunction.
  • Assessing left ventricular (LV) longitudinal and circumferential deformation may differentiate CP and RCM.

Purpose of the Study:

  • To compare the longitudinal, circumferential, and radial mechanics of the left ventricle (LV) in patients with constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM).

Main Methods:

  • Quantified LV longitudinal, radial, and circumferential mechanics using 2D speckle tracking of B-mode cardiac ultrasound images.
  • Studied 26 patients with CP, 19 with RCM, and 21 control subjects.

Main Results:

  • CP patients showed reduced circumferential strain and torsion, with normal longitudinal mechanics compared to controls.
  • RCM patients exhibited reduced longitudinal displacement and early diastolic velocities at the LV base, with normal circumferential strain.
  • Early diastolic velocity at the LV base (E(m)) showed higher accuracy in differentiating CP from RCM than early diastolic apical untwisting velocities (E(r)).

Conclusions:

  • Left ventricular (LV) deformation is circumferentially constrained in CP and longitudinally constrained in RCM.
  • Diastolic recoil is attenuated in the respective constrained directions, uniquely differentiating the diastolic restoration mechanics in CP and RCM.
Abstract

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