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Reduced diastolic left ventricular posterior wall motion in patients with constrictive pericarditis--incidence,
H J Trappe1, G Herrmann, W G Daniel
1Department of Internal Medicine, Medical School Hannover, F.R.G.
Insights
M-mode echocardiography revealed significantly reduced diastolic left ventricular posterior wall motion amplitude in constrictive pericarditis patients compared to healthy controls. This amplitude often normalized after pericardiectomy, aiding diagnosis.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Physiology
Background:
- Constrictive pericarditis is a serious cardiac condition affecting diastolic function.
- Accurate diagnostic methods for constrictive pericarditis are crucial for timely intervention.
- Left ventricular posterior wall motion is a key indicator of diastolic function.
Purpose of the Study:
- To evaluate the diagnostic utility of M-mode echocardiography in assessing diastolic left ventricular posterior wall motion amplitude in constrictive pericarditis.
- To compare this motion amplitude between patients with constrictive pericarditis and healthy volunteers.
- To assess the impact of pericardiectomy on diastolic left ventricular posterior wall motion amplitude.
Main Methods:
- M-mode echocardiography was used to measure the amplitude of diastolic left ventricular posterior wall motion.
- Measurements were obtained in 24 patients with confirmed constrictive pericarditis and 24 healthy controls.
- Changes in amplitude were assessed before and after pericardiectomy in a subset of patients.
Main Results:
- Constrictive pericarditis patients exhibited significantly reduced diastolic left ventricular posterior wall motion amplitude (0.3 +/- 0.2 mm) compared to healthy controls (3.9 +/- 0.4 mm).
- A threshold of 2 mm clearly separated patients from controls, with no patient exceeding this value and no control falling below 3 mm.
- Post-pericardiectomy, 11 of 13 patients showed increased amplitude, with 6 returning to normal limits.
Conclusions:
- M-mode echocardiography measurement of diastolic left ventricular posterior wall motion amplitude is a highly sensitive diagnostic tool for constrictive pericarditis.
- The observed improvement in amplitude after pericardiectomy suggests its utility in monitoring treatment response.
- The amplitude reduction did not correlate with heart failure severity or left ventricular end-diastolic pressure and could not differentiate medical vs. surgical candidates.
Abstract:
In 24 patients with constrictive pericarditis proven by cardiac catheterization, the amplitude of diastolic left ventricular posterior wall motion was evaluated by M-mode echocardiography and compared to the results of 24 healthy volunteers. The amplitude was significantly less in constrictive pericarditis patients than in normal controls (0.3 +/- 0.2 mm versus 3.9 +/- 0.4 mm) (P less than 0.001). No constrictive pericarditis patient demonstrated a higher value than 2 mm whereas none of the healthy volunteers had an amplitude less than 3 mm. In 11 of 13 constrictive pericarditis patients who underwent pericardiectomy, an increase in amplitude was observed. In 6 patients the amplitude returned to normal limits after surgery. No significant correlation between the degree of heart failure or the level of left ventricular end-diastolic pressure and the reduction of the amplitude was found. In addition, the amplitude of left ventricular diastolic posterior wall motion did not allow a clear separation between patients who could be treated medically and those requiring pericardiectomy.