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Angiocardiographic differentiation of constrictive pericarditis and restrictive cardiomyopathy due to amyloidosis
Insights
Cardiac amyloidosis and constrictive pericarditis can be differentiated using specific angiographic findings. The crista supraventricularis motion is a key indicator, offering an easier diagnostic clue for differentiating these cardiac conditions.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Amyloidosis and constrictive pericarditis are cardiac conditions that can present with similar symptoms.
- Accurate differentiation is crucial for appropriate patient management and treatment.
Purpose of the Study:
- To identify and compare distinct angiographic features between cardiac amyloidosis and constrictive pericarditis.
- To establish reliable imaging criteria for differentiating these two conditions.
Main Methods:
- Comparison of cineangiocardiograms and coronary angiograms from two patients with cardiac amyloidosis and six with constrictive pericarditis.
- Detailed analysis of ventricular wall motion, atrial interaction, and coronary artery patterns.
Main Results:
- Diastolic restriction of the right ventricular free wall was observed in both conditions.
- Crista supraventricularis motion was restricted in amyloidosis but normal in constrictive pericarditis.
- Constrictive pericarditis showed subtle ventricular expansion during atrial systole ('atrial kick'), absent in amyloidosis.
- Pericardial thickening in constrictive pericarditis obscured distal coronary arteries, unlike in amyloidosis.
Conclusions:
- Angiographic evaluation can differentiate cardiac amyloidosis from constrictive pericarditis.
- Crista supraventricularis motion is a primary, easily evaluated differentiator.
- Combined assessment of ventricular and atrial dynamics, along with coronary artery visualization, aids diagnosis.
Abstract:
The cineangiocardiograms and coronary angiograms of two cases of amyloidosis of the heart were compared to six cases of constrictive pericarditis. Three angiographic differentiating points were seen: (1) right ventricular free wall motion showed diastolic restriction in both disorders, whereas the crista supraventricularis, which moved normally in constrictive pericarditis, demonstrated restriction in amyloidosis; (2) ventricles in cases of constrictive pericarditis showed subtle further expansion during atrial systole after initial rapid filling (atrial kick), while in both cases of amyloidosis there was no motion during atrial systole; (3) pericardial thickening in constrictive pericarditis was demonstrated by failure of the distal coronary arteries to reach the surface of the cardiac image. In amyloidosis, the distal coronary arteries normally reached the periphery of the image. All three signs may be useful in differentiation, but the first is the easiest to evaluate. The right anterior oblique or posteroanterior view is the recommended projection.