Division of Cardiovascular Disease, John Ochsner Heart and Vascular Institute, New Orleans, Louisiana.
Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cardiovascular Section, Cleveland Clinic, Cleveland, Ohio.
Am J Cardiol. 2019 Sep 15;124(6):932-938. doi: 10.1016/j.amjcard.2019.06.002. Epub 2019 Jun 25.
Constrictive Pericarditis (CP) is a curable and reversible form of severe diastolic heart failure. We aimed to investigate the diagnostic accuracy of published echocardiographic Mayo Clinic Criteria in differentiating 107 patients with surgically proven CP from 30 patients with restrictive cardiomyopathy due to cardiac Amyloidosis. Five principal echocardiographic and Doppler variables were remeasured on preoperative transthoracic echocardiogram namely (1) respiration-related ventricular septal shift; (2) respiratory variation in mitral inflow E pulsed Doppler velocity; 3) tissue Doppler medial mitral annular e' velocity; (4) ratio of medial mitral annular e' to lateral mitral annular e' velocity; and 5) hepatic vein (HV) pulsed Doppler diastolic flow reversal ratio. Etiology of CP included viral/idiopathic or autoimmune (75%), postcardiac surgery (13%) and postradiation (7%). Univariate logistic regression analysis showed that (1) respiration related ventricular septal shift, (2) percentage change in Mitral E velocity, (3) medial e' velocity ≥9 cm/sec, (4) medial e'/lateral e' ratio ≥0.91, (5) HV diastolic reversal ratio ≥0.79 were associated with the diagnosis of CP. Multivariable logistic regression analyses showed that medial e' velocity ≥9 cm/s was independently associated with the diagnosis of CP. Respiration related ventricular septal shift had the highest sensitivity, whereas medial e' velocity ≥9 cm/s has the highest specificity to diagnose CP (Areas under curves 0.99, p 0.001). Combining respiration related ventricular septal shift with medial e' velocity ≥9 cm/s gave a desirable sensitivity (80%) and specificity (92%). Adding reversal ratio to this combination further increased the specificity (97%) but dropped the sensitivity (70%) to diagnose CP.
缩窄性心包炎（CP）是一种可治愈和可逆转的严重舒张性心力衰竭形式。我们旨在研究已发表的超声心动图 Mayo 诊所标准在区分 107 例经手术证实的 CP 患者和 30 例因心脏淀粉样变性导致限制型心肌病患者中的诊断准确性。在术前经胸超声心动图上重新测量了五个主要的超声心动图和多普勒变量，即（1）呼吸相关室间隔移位；（2）呼吸二尖瓣流入道 E 脉冲多普勒速度变化；（3）组织多普勒中二尖瓣环 e'速度；（4）中二尖瓣环 e'与外侧二尖瓣环 e'速度比；和（5）肝静脉（HV）脉冲多普勒舒张期血流反转比。CP 的病因包括病毒/特发性或自身免疫性（75%）、心脏手术后（13%）和放疗后（7%）。单变量逻辑回归分析显示，（1）呼吸相关室间隔移位，（2）二尖瓣 E 速度变化百分比，（3）中 e'速度≥9cm/sec，（4）中 e'/外侧 e'比≥0.91，（5）HV 舒张期反转比≥0.79 与 CP 的诊断相关。多变量逻辑回归分析显示，中 e'速度≥9cm/s 与 CP 的诊断独立相关。呼吸相关室间隔移位的敏感性最高，而中 e'速度≥9cm/s 的特异性最高（曲线下面积 0.99，p<0.001）。将呼吸相关室间隔移位与中 e'速度≥9cm/s 相结合，可获得理想的敏感性（80%）和特异性（92%）。将反转比加入该组合可进一步提高特异性（97%），但降低敏感性（70%）以诊断 CP。
