From the Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (T.D.W.); Geisel School of Medicine at Dartmouth, Hanover, NH (T.D.W.); National University Heart Center, Singapore, Singapore (L.H.L.); Yong Loo Lin School of Medicine, Singapore, Singapore (L.H.L.); and Division of Cardiovascular Diseases (R.E.E., N.S.A., J.K.O.), Department of Health Sciences Research (H.J.W., B.D.L.), and Division of Cardiovascular Surgery (H.V.S.), Mayo Clinic, Rochester, MN.
Circ Cardiovasc Imaging. 2014 May;7(3):526-34. doi: 10.1161/CIRCIMAGING.113.001613. Epub 2014 Mar 14.
Constrictive pericarditis is a potentially reversible cause of heart failure that may be difficult to differentiate from restrictive myocardial disease and severe tricuspid regurgitation. Echocardiography provides an important opportunity to evaluate for constrictive pericarditis, and definite diagnostic criteria are needed.
Patients with surgically confirmed constrictive pericarditis (n=130) at Mayo Clinic (2008-2010) were compared with patients (n=36) diagnosed with restrictive myocardial disease or severe tricuspid regurgitation after constrictive pericarditis was considered but ruled out. Comprehensive echocardiograms were reviewed in blinded fashion. Five principal echocardiographic variables were selected based on prior studies and potential for clinical use: (1) respiration-related ventricular septal shift, (2) variation in mitral inflow E velocity, (3) medial mitral annular e' velocity, (4) ratio of medial mitral annular e' to lateral e', and (5) hepatic vein expiratory diastolic reversal ratio. All 5 principal variables differed significantly between the groups. In patients with atrial fibrillation or flutter (n=29), all but mitral inflow velocity remained significantly different. Three variables were independently associated with constrictive pericarditis: (1) ventricular septal shift, (2) medial mitral e', and (3) hepatic vein expiratory diastolic reversal ratio. The presence of ventricular septal shift in combination with either medial e'≥9 cm/s or hepatic vein expiratory diastolic reversal ratio ≥0.79 corresponded to a desirable combination of sensitivity (87%) and specificity (91%). The specificity increased to 97% when all 3 factors were present, but the sensitivity decreased to 64%.
Echocardiography allows differentiation of constrictive pericarditis from restrictive myocardial disease and severe tricuspid regurgitation. Respiration-related ventricular septal shift, preserved or increased medial mitral annular e' velocity, and prominent hepatic vein expiratory diastolic flow reversals are independently associated with the diagnosis of constrictive pericarditis.
缩窄性心包炎是一种潜在的可逆转的心力衰竭病因，可能难以与限制型心肌疾病和重度三尖瓣反流相区分。超声心动图为评估缩窄性心包炎提供了重要机会，因此需要明确的诊断标准。
在梅奥诊所（2008-2010 年），对经手术证实的缩窄性心包炎患者（n=130）与缩窄性心包炎考虑但排除后诊断为限制型心肌疾病或重度三尖瓣反流的患者（n=36）进行了比较。以盲法方式对全面的超声心动图进行了回顾。根据先前的研究和临床应用的潜力，选择了五个主要的超声心动图变量：（1）呼吸相关的室间隔移位，（2）二尖瓣流入 E 速度的变化，（3）内侧二尖瓣环 e'速度，（4）内侧二尖瓣环 e'与外侧 e'的比值，和（5）肝静脉呼气舒张期反向比。两组间的所有 5 个主要变量均有显著差异。在心房颤动或扑动患者中（n=29），除了二尖瓣流入速度外，所有其他变量均有显著差异。三个变量与缩窄性心包炎独立相关：（1）室间隔移位，（2）内侧二尖瓣 e'，和（3）肝静脉呼气舒张期反向比。室间隔移位与内侧 e'≥9cm/s或肝静脉呼气舒张期反向比≥0.79的存在相结合，对应于敏感性（87%）和特异性（91%）的理想组合。当所有 3 个因素都存在时，特异性增加到 97%，但敏感性降低至 64%。
超声心动图可将缩窄性心包炎与限制型心肌疾病和重度三尖瓣反流区分开来。呼吸相关的室间隔移位、保留或增加的内侧二尖瓣环 e'速度和明显的肝静脉呼气舒张期反流与缩窄性心包炎的诊断独立相关。
