Fig 4 algorithm illustrating the diagnosis of constrictive pericarditis by transthoracic echocardiography a late mitral inflow velocity, e early mitral inflow velocity. It has been observed that ptients with constrictive pericarditis have a characteristic doppler pattern of respiratory variation in. Mayo clinic is a leader in clinical research in the diagnosis and management of pericardial diseases. Comparison of etiologic factors in transient constrictive physiology with those reported in a recent study of 5 patients requiring pericardiectomy for treatment of constrictive pericarditis from 1985 through 1995 at mayo clinic. Patients with the clinical, operative, and pathological features. No laboratory data are diagnostic of constrictive pericarditis. Echocardiography diagnostic criteria for constriction.
It can be idiopathic, familial, or secondary to systematic disorders. Constrictive pericarditis curable paradoxical diastolic heart failure ase ebrc 2018 jae k. Constrictive pericarditis cp is a potentially reversible cause of heart failure that can pose a diagnostic challenge. Mayo clinic is committed to taking care of our patients, learners and staff. This study was conducted to assess the diagnostic role of doppler echocardiography in constrictive pericarditis. T1 echocardiographic diagnosis of constrictive pericarditis mayo clinic criteria. Specific diagnostic echocardiographic criteria for the diagnosis of constrictive pericarditis has been recently proposed by the mayo clinic and include. We aimed to investigate the diagnostic accuracy of. The mayo clinic echocardiography and cardiac catheterization haemodynamic diagnostic criteria for constrictive pericarditis are based on the. Constrictive pericarditis curable paradoxical diastolic. Effusiveconstrictive pericarditis effusiveconstrictive pericarditis is characterized by underlying constrictive physiology with a coexisting pericardial effusion, often with cardiac tamponade. Oh, md samsung professor of cv diseases director, pericardial disease clinic may 8th, 2018 codirector, integrated cv imaging 2018 mfmer 37120032 constrictive pericarditis contents clinical features and diagnostic criteria symptoms and signs. Backgroundconstrictive pericarditis is a potentially reversible cause of heart failure that may be difficult to differentiate.
Diagnosis is based on symptoms, a friction rub, electrocardiographic changes, and evidence of pericardial fluid accumulation on xray or echocardiogram. The study population consisted of patients with surgically confirmed constrictive pericarditis at the mayo clinic rochester, mn from january 2008 to december 2010. Echocardiography provides an important opportunity to evaluate for constrictive pericarditis, and definite diagnostic criteria are needed. This disorder must be considered in the differential diagnosis for unexplained heart failure, particularly when the left ventricular ejection fraction is preserved. This treatable cause of heart failure should be considered in all patients with unexplained right heart failure symptoms or signs, especially when the left ventricular ejection fraction is preserved. Between january 1985 and december 2004 at our institution, 395 consecutive patients 276 males underwent pericardiectomy for constrictive pericarditis. Differentiating constriction from restriction from the mayo clinic. The diagnosis is often challenged by nonspecific symptoms, discrepant investigation results, and a low level of suspicion.
Constrictive pericarditis is a disorder of cardiac filling caused by an inelastic pericardium. Further evaluation helped make a diagnosis of constrictive pericarditis. Multimodality cardiovascular imaging plays vital roles in the diagnosis and management of these pericardial conditions, providing structural, functional and. Pericarditis cardiovascular disorders merck manuals. Differentiating constriction from restriction from the mayo clinic echocardiographic criteria. Marked increase in left andor right ventricular filling pressures causes symptoms and signs of congestive heart failure. Constrictive pericarditis cp is an uncommon diagnosis in the modern day. Nevertheless, timely recognition remains crucial, as it is a potentially curable condition. Cardiac output may be greatly reduced if cardiac tamponade or constrictive pericarditis develops. Home latest in cardiology echocardiographic diagnosis of constrictive pericarditis. Disorders of the pericardium include a diverse spectrum of clinical conditions, ranging from common conditions such as acute pericarditis, to rare entities, such as congenital absence of the pericardium 1, 2. Constrictive pericarditis cp is a form of diastolic heart failure caused by an inelastic pericardium that inhibits cardiac filling. Constrictive pericarditis cp is a curable and reversible form of severe diastolic heart failure.
Backgroundconstrictive pericarditis is a potentially reversible cause of. These symptoms are often similar to those associated. Importance of clinical and laboratory findings in the. In this manuscript, we aim to summarize echocardiographic characteristics of cp with a focus on parameters discriminating cp from. Constrictive pericarditisa curable diastolic heart failure nature. The mayo clinic cardiothoracic surgical database was searched for all cases that included pericardiectomy. Three variables were independently associated with constrictive pericarditis. Noninvasive and invasive diagnostic criteria for constrictive pericarditis have been developed at mayo. Constrictive pericarditis radiology reference article. The fundamental pathophysiologic mechanisms in constrictive pericarditis include dissociation of intrathoracic and intracardiac pressures along with interventricular coupling or dependence within a fixed space. The mayo clinic echocardiographic criteria for the diagnosis of constrictive pericarditis, which has 87% sensitivity and 97% specificity, is currently the widely accepted approach.
Constrictive pericarditis diagnosis, echocardiography and. Constrictive pericarditis, still a diagnostic challenge. Constrictive pericarditis is a potentially reversible cause of heart failure that may be difficult to differentiate from restrictive myocardial disease and severe tricuspid regurgitation. 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. Because its treatment differs markedly from all other forms of heart failure, accu rate diagnosis is imperative. In patients with atrial fibrillation or flutter n 29, all but mitral inflow velocity remained significantly different. Constrictive pericarditis cp is a form of diastolic heart failure that arises because an inelastic pericardium inhibits cardiac filling.
Ephemeral effusive constrictive pathophysiology jacc. Comparison of mitral inflow and superior vena cava doppler velocities in chronic obstructive pulmonary disease and constrictive pericarditis. Patients symptoms may develop slowly over a number of years, so that they may not be aware of all of their symptoms until questioned. Echocardiographic diagnosis of constrictive pericarditis. To prepare for a potential broadening of the covid19 outbreak and to help protect our communities, mayo clinic department of cardiovascular medicine education is suspending live courses and conferences through july 30, 2020. Differentiating constriction from restriction from the. Diagnosing constrictive pericarditis remains challenging, and the most effective tools are designed. Clinically, cp and restrictive cardiomyopathy can present in a similar fashion.
The mayo clinic criteria for diagnosis of cp are incorporated into a practical algorithm that could be used as part of a comprehensive diagnostic workup. Mayo clinic patients with surgicallyconfirmed cp n1 in. Notable trends were an increasing frequency of cp due to cardiac surgery and mediastinal radiation patients who. Echocardiography diagnostic criteria for constriction american. It is an infrequent cause of heart failure hf, poorly diagnosed because of its peculiar pathophysiology. The mayo clinic echocardiography diagnostic criteria presents a diagnostic paradigm where the presence of mitral in. To our knowledge, this is the largest and only blinded evaluation of modern echocardiographic criteria for the diagnosis of constrictive pericarditis among patients presenting with heart failure. Echocardiographic diagnosis of constrictive pericarditis mayo clinic. Read modern echocardiographic diagnosis of constrictive pericarditis, journal of the american college of cardiology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Constrictive pericarditis in the modern era novel criteria for diagnosis in the cardiac cath laboratory talreja, nishimura, oh, holmes. Echocardiographic diagnosis of constrictive pericarditis mayo. Utility of multimodality cardiac imaging in disorders of. Echocardiography provides an important opportunity to evaluate for constrictive pericarditis, and.
However, as a result of the nearly universal findings of a chronically elevated rightsided atrial pressure and passive congestion of the liver, kidneys, and gastrointestinal gi tract, resultant abnormalities may. Echo diagnostic criteria septal motion abnormality mv flow velocity restrictive ea 1. The mayo clinic cardiac catheterization, echocardiography, and. This study will provide answers to persisting questions about volume changes during respiration in patients with constrictive pericarditis. This usually results in a mixed hemodynamic picture with features of. Effusiveconstrictive pericarditis is a clinical hemodynamic syndrome in which constriction of the heart by the visceral pericardium occurs in the presence of tense effusion in a free. Boonyaratavej s, oh jk, tajik aj, appleton cp, seward jb. In these patients, echocardiographic features of constrictive pathophysiology were more common prior to pericardiocentesis, and only 2 patients eventually. Electrocardiographic findings are nonspecific and include atrioventricular conduction and qrs complex abnormalities and. Constrictive pericarditis or perhaps better termed pericardial constriction is a type of pericarditis which leads to diastolic dysfunction and potentially symptoms of right heart failure. The publication of the 17 t h edition of medical knowledge selfassessment program mksap represents nearly a halfcentury of serving as the goldstandard resource for internal medicine education. The mayo clinic echocardiography and cardiac catheterization haemodynamic diagnostic criteria for constrictive pericarditis are based on the unique features of ventricular interdependence and. Thus, it is reasonable to propose echocardiographic diagnostic criteria for effusiveconstrictive pericarditis which may include.
Pericardial diseases online cardiology courses mayo clinic. Suggested diagnostic algorithm for the echocardiographic diagnosis of constrictive pericarditis cp. Pathophysiology, diagnosis, echocardiography and treatment are being explained a presentation with images and videos of the. Causes of transient and nontransient constrictive pericarditis. Constrictive pericarditisa curable diastolic heart. Making that diagnosis may be difficult, as cp may mimic other disorders. Constrictive pericarditis cp is a rare cause of heart failure and is characterized by impaired chamber filling owing to a fibrotic pericardium encasing the heart. New methods to diagnose constrictive pericarditis mayo. Constrictive pericarditis presenting with massive ascites. 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. Request pdf echocardiographic diagnosis of constrictive pericarditis mayo clinic criteria constrictive pericarditis is a potentially reversible cause of heart. Because constrictive pericarditis presents with a myriad of symptoms, making a diagnosis solely on the basis of the clinical history is virtually impossible.
Echocardiography provides an important opportunity to evaluate for constrictive pericarditis, and defnite diagnostic criteria are needed. From this cohort, 33 patients 16% were diagnosed with effusive constrictive pericarditis. A contemporary spectrum of constrictive pericarditis in 5 patients evaluated at the mayo clinic from 1985 through 1995 was compared with that of a historic cohort of 231 patients from 1936 through 1982. The investigators performed a retrospective cohort study of 205 consecutive patients with pre and postpericardiocentesis echocardiograms at the mayo clinic between january 2006 and december 2007. Restrictive cardiomyopathy rcm is the least common among cardiomyopathies. Constrictive pericarditis cp results from loss of pericardial elasticity, which generates a restrictive syndrome. This study provides the first blinded evaluation of the diagnostic accuracy of 5 modern echocardiographic parameters.
826 402 330 685 1332 1378 780 862 509 911 919 95 75 535 1189 881 1154 625 1272 1188 313 357 396 357 110 549 424 1318 462 451 607 578 1388 1229 1382 594 623 979 1159 955 1348 1077 1257 697 1445 820