Redefining Effusive-Constrictive Pericarditis with Echocardiography
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Background: Effusive-constrictive pericarditis (ECP) is traditionally diagnosed by using the expensive and invasive techniqueof direct pressure measurements in the pericardial space and the right atrium. The aim of this study was to assess the diagnosticrole of echocardiography in tuberculous ECP. Methods: Intrapericardial and right atrial pressures were measured pre- and post-pericardiocentesis, and right ventricular andleft ventricular pressures were measured post-pericardiocentesis in patients with tuberculous pericardial effusions. Echocardiographywas performed post-pericardiocentesis. Traditional, pressure-based diagnostic criteria were compared with post-pericardiocentesissystolic discordance and echocardiographic evidence of constriction. Results: Thirty-two patients with tuberculous pericardial disease were included. Sixteen had ventricular discordance (invasivelymeasured), 16 had ECP as measured by intrapericardial and right atrial invasive pressure measurements and 17 had ECP determinedechocardiographically. The sensitivity and specificity of pressure-guided measurements (compared with discordance) forthe diagnosis of ECP were both 56%. The positive and negative predictive values were both 56%. The sensitivity of echocardiography(compared with discordance) for the diagnosis of ECP was 81% and the specificity 75%, while the positive and the negativepredictive values were 76% and 80%, respectively. Conclusion: Echocardiography shows a better diagnostic performance than invasive, pressure-based measurements for the diagnosisof ECP when both these techniques are compared with the gold standard of invasively measured systolic discordance.
Abstract
Background: Effusive-constrictive pericarditis (ECP) is traditionally diagnosed by using the expensive and invasive techniqueof direct pressure measurements in the pericardial space and the right atrium. The aim of this study was to assess the diagnosticrole of echocardiography in tuberculous ECP. Methods: Intrapericardial and right atrial pressures were measured pre- and post-pericardiocentesis, and right ventricular andleft ventricular pressures were measured post-pericardiocentesis in patients with tuberculous pericardial effusions. Echocardiographywas performed post-pericardiocentesis. Traditional, pressure-based diagnostic criteria were compared with post-pericardiocentesissystolic discordance and echocardiographic evidence of constriction. Results: Thirty-two patients with tuberculous pericardial disease were included. Sixteen had ventricular discordance (invasivelymeasured), 16 had ECP as measured by intrapericardial and right atrial invasive pressure measurements and 17 had ECP determinedechocardiographically. The sensitivity and specificity of pressure-guided measurements (compared with discordance) forthe diagnosis of ECP were both 56%. The positive and negative predictive values were both 56%. The sensitivity of echocardiography(compared with discordance) for the diagnosis of ECP was 81% and the specificity 75%, while the positive and the negativepredictive values were 76% and 80%, respectively. Conclusion: Echocardiography shows a better diagnostic performance than invasive, pressure-based measurements for the diagnosisof ECP when both these techniques are compared with the gold standard of invasively measured systolic discordance.
참고문헌 (18)
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