Heart and Vascular Institute and Imaging Institute, Cleveland Clinic, Cleveland, OH 44195, USA. .
Circ Cardiovasc Imaging. 2013 May 1;6(3):399-406. doi: 10.1161/CIRCIMAGING.112.000078. Epub 2013 Mar 26.
The aim of our study was to compare myocardial mechanics of constrictive pericarditis (CP) with restrictive cardiomyopathy (RCM), or healthy controls; to assess the impact of pericardial thickening detected by cardiac magnetic resonance on regional myocardial mechanics in CP; and to quantitate the effect of pericardiectomy on myocardial mechanics in CP.
Myocardial mechanics were evaluated by 2-dimensional speckle tracking in 52 consecutive patients with CP who underwent cardiac magnetic resonance examination before pericardiectomy, 35 patients with RCM, and 26 control subjects. CP patients had selectively depressed left ventricular (LV) anterolateral wall strain (LWS) and right ventricular (RV) free wall longitudinal systolic strain (FWS) but preserved LV septal wall systolic strain (SWS). In a comparison of RCM and normals, CP patients had significantly lower regional longitudinal systolic strain ratios (CP versus RCM and normal; LVLWS/LVSWS: 0.8±0.2 versus 1.1±0.2 and 1.0±0.2; P<0.001, RVFWS/LVSWS: 0.8±0.4 vs. 1.4±0.5 and 1.2±0.2; P<0.001). LVLWS/LVSWS was more robust than the LV lateral wall to LV septal wall ratio of early diastolic velocities at the LV base (LE'/SE') in differentiating CP from RCM (area under the curve=0.91 versus 0.76; P=0.011). There was a significant inverse correlation between pericardial thickness and respective ventricular strains (P=0.001). Pericardiectomy resulted in the improvement of the depressed LVLWS/LVSWS (0.83±0.18-0.95±0.12; P<0.001).
Regional longitudinal systolic strain ratios are robust novel diagnostic tools for CP. Regional myocardial mechanics inversely correlates with adjacent pericardial segment thickness detected by cardiac magnetic resonance, and pericardiectomy leads to systolic strain improvement, which is more pronounced in right ventricular and LV free walls.
本研究旨在比较缩窄性心包炎（CP）与限制型心肌病（RCM）或健康对照者的心肌力学；评估心脏磁共振检测到的心包增厚对 CP 患者局部心肌力学的影响；并定量分析心包切除术对 CP 患者心肌力学的影响。
对 52 例连续接受心包切除术的 CP 患者、35 例 RCM 患者和 26 例对照组患者进行二维斑点追踪评估心肌力学。CP 患者的左心室（LV）前外侧壁应变（LWS）和右心室（RV）游离壁纵向收缩应变（FWS）选择性降低，但 LV 间隔壁收缩应变（SWS）保留。与 RCM 和正常组相比，CP 患者的局部纵向收缩应变比值明显降低（CP 与 RCM 和正常组相比；LVLWS/LVSWS：0.8±0.2 比 1.1±0.2 和 1.0±0.2；P<0.001，RVFWS/LVSWS：0.8±0.4 比 1.4±0.5 和 1.2±0.2；P<0.001）。与 LV 侧壁至 LV 间隔的早期舒张速度比（LE'/SE'）相比，LVLWS/LVSWS 更能准确地区分 CP 和 RCM（曲线下面积=0.91 比 0.76；P=0.011）。心包厚度与相应心室应变呈显著负相关（P=0.001）。心包切除术导致 LVLWS/LVSWS 降低（0.83±0.18-0.95±0.12；P<0.001）。
局部纵向收缩应变比值是 CP 的新型诊断工具。局部心肌力学与心脏磁共振检测到的相邻心包节段厚度呈负相关，心包切除术可导致收缩应变改善，右心室和 LV 游离壁的改善更为明显。
