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A Simplified Method for the Diagnosis of Constrictive Pericarditis in the Cardiac Catheterization Laboratory
C Charles Jain1, William R Miranda1, Abdallah El Sabbagh2
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Insights
Pulmonary artery and aorta ejection times (ETs) during respiration can diagnose constrictive pericarditis (CP). Changes in these ETs effectively identify enhanced ventricular interdependence, a key CP diagnostic criterion.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Diagnostic Imaging
Background:
- Enhanced ventricular interdependence is crucial for diagnosing constrictive pericarditis (CP).
- Simultaneous ventricular measurements during cardiac catheterization are challenging.
- Ejection times (ETs) from arterial pressure tracings correlate with stroke volumes and are easily measured.
Purpose of the Study:
- To evaluate respirophasic changes in pulmonary artery (PA) ETs and aorta (Ao) ETs.
- To determine if these ET changes can serve as a marker for enhanced ventricular interdependence in CP diagnosis.
Main Methods:
- Retrospective analysis of simultaneous left and right heart catheterizations (2006-2017) at Mayo Clinic.
- Inclusion of patients with inconclusive noninvasive evaluations for CP.
- Measurement of PA and Ao ETs during inspiration and expiration to assess ventricular interaction.
Main Results:
- Patients with CP showed a significantly greater decrease in PA ET during expiration vs inspiration (-31.8 ms vs 5.1 ms; P<.001).
- The difference in Ao ET minus PA ET during the respiratory cycle was significantly greater in CP patients (50.8 ms vs 5.4 ms; P<.001).
- No significant demographic or baseline hemodynamic differences were observed between CP and non-CP groups.
Conclusions:
- Pulmonary artery and aorta ejection time measurements throughout the respiratory cycle are simple and accurate for diagnosing CP.
- Respirophasic ET analysis provides a valuable, easily obtainable parameter for assessing ventricular interdependence in CP.
Importance:
Enhanced ventricular interdependence is a highly sensitive and specific criterion for the diagnosis of constrictive pericarditis (CP), but simultaneous ventricular measurements can be challenging at cardiac catheterization. Ejection times (ETs) correlate with stroke volumes and can be easily measured from arterial pressure tracings.
Objective:
To assess respirophasic changes in pulmonary artery (PA) ETs and aorta (Ao) ETs as a marker for enhanced ventricular interdependence.
Design, Setting, And Participants:
Retrospective analysis of simultaneous left-side and right-side heart catheterizations between January 2006 and January 2017 was performed. The data were analyzed in June 2020. All catheterizations were performed at the Mayo Clinic, Rochester, Minnesota. This study evaluated patients undergoing left-side and right-side heart catheterization for assessment of CP after noninvasive evaluation was inconclusive.
Main Outcomes And Measures:
Measurements of the PA and Ao ETs were made during inspiration and expiration. Ventricular interaction was mainly assessed by evaluating the difference of ETs from expiration to inspiration as well as the difference in Ao minus the difference in PA.
Results:
A total of 10 patients with surgically proven CP and 10 patients without CP (restrictive cardiomyopathy or severe tricuspid regurgitation) were identified. Of these 20 included patients, 10 (50%) were female, and the median (interquartile range) age was 59.5 (47.0-67.5) years. There were no significant differences in demographic characteristics or baseline hemodynamic measurements. In patients with CP compared with those without CP, there was a significantly greater decrease in PA ET (mean [SD], -31.8 [28.6] vs 5.1 [9.5]; P < .001) and a nonsignificantly greater increase in Ao ET (mean [SD], 19.0 [15.7] vs 10.5 [9.1]; P = 0.20) during expiration vs inspiration. Thus, the difference in Ao ET minus the difference in PA ET during expiration vs inspiration was significantly greater in those with CP compared with those without CP (mean [SD], 50.8 [22.5] milliseconds vs 5.4 [15.2] milliseconds; P < .001).
Conclusions And Relevance:
In this study, PA and Ao measurements of ETs throughout the respiratory cycle were a simple, easily obtainable, and accurate parameter for the diagnosis of CP.
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