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Differentiation of restrictive cardiomyopathy from pericardial constriction: assessment of diastolic function by
C N Aroney1, T D Ruddy, H Dighero
1Department of Medicine, Massachusetts General Hospital, Boston 02114.
Insights
Diastolic filling patterns differ between restrictive cardiomyopathy and pericardial constriction. Pericardial constriction shows faster filling and higher early filling fractions compared to restrictive cardiomyopathy and normal subjects.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Diastolic dysfunction is a hallmark of several cardiac conditions.
- Distinguishing between restrictive cardiomyopathy and pericardial constriction based on diastolic filling is clinically important.
Purpose of the Study:
- To compare diastolic filling variables between patients with restrictive cardiomyopathy and pericardial constriction.
- To differentiate hemodynamic features of constriction using diastolic filling parameters.
Main Methods:
- Studied 12 patients with hemodynamic constriction (5 restrictive cardiomyopathy, 5 pericardial constriction, 2 combined).
- Compared diastolic filling fractions and time to peak filling rate with 10 normal subjects.
- Analyzed atrial contribution to left ventricular filling.
Main Results:
- Patients with pericardial constriction had significantly higher early diastolic filling fractions than restrictive cardiomyopathy and normal subjects.
- Time to peak filling rate was shorter in pericardial constriction compared to restrictive cardiomyopathy and normal subjects.
- Restrictive cardiomyopathy showed a higher percentage of atrial contribution to left ventricular filling.
Conclusions:
- Diastolic filling patterns can differentiate pericardial constriction from restrictive cardiomyopathy.
- Pericardial constriction is characterized by enhanced early diastolic filling and faster filling rates.
- Restrictive cardiomyopathy is associated with a greater reliance on atrial contraction for ventricular filling.
Abstract:
Diastolic filling variables were studied in 12 patients with the hemodynamic features of constriction, of whom 5 had restrictive cardiomyopathy, 5 had pericardial constriction and 2 had combined pericardial constriction and restrictive cardiomyopathy. The values were compared with those in 10 normal subjects of comparable age. The filling fractions between 10% and 70% of the diastolic time interval were greater in patients with pericardial constriction than in those with restrictive cardiomyopathy (p less than 0.01 between 20% and 50%, p less than 0.05 at 10%, 60% and 70%), with no overlap. The filling fractions in patients with pericardial constriction were also greater than those in normal subjects between 10% and 60% of the diastolic time interval. The filling fraction was lower in patients with restrictive cardiomyopathy than in normal subjects at 40% of the diastolic time interval (p less than 0.05). The time to peak filling rate in patients with pericardial constriction was shorter (110 +/- 14 ms) than in those with restrictive cardiomyopathy (195 +/- 45 ms, p less than 0.01) or in normal subjects (173 +/- 32 ms, p less than 0.01). The percent of atrial contribution to left ventricular filling was higher in those with restrictive cardiomyopathy (45 +/- 17%) than in those with pericardial constriction (21 +/- 6%, p less than 0.05) or in normal subjects (24 +/- 9%, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)