Mookadam Farouk, Jiamsripong Panupong, Raslan Serageldin F, Panse Prasad M, Tajik A Jamil
Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, USA.
Future Cardiol. 2011 Jul;7(4):471-83. doi: 10.2217/fca.11.18.
The differentiation between constrictive pericarditis and restrictive cardiomyopathy can be clinically challenging. Pericardial constriction results from scarring and consequent loss of pericardial elasticity leading to impaired ventricular filling. Restrictive cardiomyopathy is characterized by a nondilated rigid ventricle, severe diastolic dysfunction and restrictive filling producing hemodynamic changes, similar to those in constrictive pericarditis. While constrictive pericarditis is usually curable by surgical treatment, restrictive cardiomyopathy requires medical therapy and in appropriate patients, the definitive treatment is cardiac transplantation. Sufficient differences exist between the two conditions to allow noninvasive differentiation, but no single diagnostic tool can be relied upon to make this distinction. Newer echocardiographic techniques such as speckle-track imaging, velocity vector imaging, as well as cardiac computed tomography and cardiac MRI can help differentiate constriction from restriction with high sensitivity and specificity. Outcomes are better with early diagnosis of constriction in particular and early surgical resection.
缩窄性心包炎与限制型心肌病的鉴别在临床上具有挑战性。心包缩窄是由瘢痕形成以及随之而来的心包弹性丧失导致心室充盈受损引起的。限制型心肌病的特征是心室不扩张且僵硬、严重舒张功能障碍以及限制性充盈，从而产生与缩窄性心包炎相似的血流动力学变化。虽然缩窄性心包炎通常可通过手术治疗治愈，但限制型心肌病需要药物治疗，对于合适的患者，最终治疗方法是心脏移植。这两种情况之间存在足够的差异以进行无创鉴别，但没有单一的诊断工具可以依靠来做出这种区分。诸如斑点追踪成像、速度向量成像等更新的超声心动图技术，以及心脏计算机断层扫描和心脏磁共振成像，有助于以高灵敏度和特异性区分缩窄与限制。特别是早期诊断缩窄并进行早期手术切除，预后会更好。
