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Restrictive cardiomyopathy and constrictive pericarditis: non-invasive distinction by digitised M mode
J M Morgan1, L Raposo, J C Clague
1Cardiac Department, Brompton Hospital, London.
Insights
Distinguishing restrictive cardiomyopathy from constrictive pericarditis is challenging. Echocardiogram analysis using digitisation aids in differentiating these conditions by examining posterior wall function, improving diagnostic accuracy.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Techniques
Background:
- Differentiating restrictive cardiomyopathy (RCM) and constrictive pericarditis (CP) is clinically difficult.
- Cardiac catheterisation, the gold standard, may not always provide a definitive diagnosis.
Purpose of the Study:
- To evaluate the utility of digitised M-mode echocardiography in distinguishing RCM from CP.
- To identify specific echocardiographic parameters indicative of RCM versus CP.
Main Methods:
- Digitisation of M-mode echocardiograms from 15 RCM patients, 10 CP patients, and 20 controls using a Summagraphics digitiser and Prime 750 computer.
- Analysis of key left ventricular function variables, including fractional shortening, filling/emptying rates, and posterior wall thickening/thinning rates.
Main Results:
- RCM patients showed significantly reduced fractional shortening, peak filling/emptying rates, and posterior wall thickening/thinning rates compared to controls.
- CP patients had significantly reduced peak filling and posterior wall thinning rates, with an increased posterior wall thinning rate.
- Significant differences between RCM and CP included decreased peak left ventricular emptying rate, percentage posterior wall thickening, and peak posterior wall thickening/thinning rates in RCM.
Conclusions:
- Digitised M-mode echocardiography, focusing on posterior wall function, can be a valuable tool.
- This technique may serve as an adjunct to cardiac catheterisation for improved differentiation of RCM and CP.
Abstract:
It is difficult to distinguish between restrictive cardiomyopathy and constrictive pericarditis on the basis of clinical findings and simple investigation. Cardiac catheterisation has been the reference standard for diagnosis but even this does not always permit an accurate distinction. A Summagraphics digitiser and Prime 750 computer system were used to digitise the echocardiograms of 15 patients with restrictive cardiomyopathy, 10 with constrictive pericarditis and a group of 20 age and sex matched normal subjects of similar age and sex distribution. Compared with controls, patients with restrictive cardiomyopathy showed a significant reduction in the following variables (a) decreased fractional shortening, (b) decreased peak left ventricular filling and emptying rates, (c) decreased percentage posterior wall thickening, and (d) decreased peak left ventricular posterior wall thickening and thinning rates. Whereas patients with constrictive pericarditis only had significantly reduced peak left ventricular filling and posterior wall thinning rates and significantly increased posterior wall thinning rate. When patients with restrictive cardiomyopathy were compared with those with constrictive pericarditis the significant differences were: (a) decreased peak left ventricular emptying rate, (b) decreased percentage posterior wall thickening, and (c) decreased peak left ventricular posterior wall thickening and thinning rates. Digitisation of M mode echocardiograms, with particular attention to posterior wall function, may be a useful adjunct to cardiac catheterisation in distinguishing restrictive cardiomyopathy from constrictive pericarditis.