A Potential Echocardiographic Classification for Constrictive Pericarditis Based on Analysis of Abnormal Septal Motion
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Background: Constrictive pericarditis is an uncommon condition that could be easily confused with congestive heart failure. In symptomatic patients, septal “wobble” on echocardiography may be an important sign of constrictive physiology. This studywas planned to investigate the effects of constriction on septal motion as identified by echocardiography. Methods: In this retrospective observational study, nine consecutive patients with constriction underwent carefulechocardiographic analysis of the interventricular septum (IVS) with slow motion 2-dimensional echocardiography andinspiratory manoeuvres. Six patients who had undergone cardiac magnetic resonance imaging underwent similar analysis. Findings were correlated with haemodynamic data in five patients who had undergone cardiac catheterisation studies. Results: In mild cases of constriction a single wobble of the IVS was seen during normal respiration. In more moderate cases adouble motion of the septum (termed “double wobble”) was seen where the septum bowed initially into the left ventricle (LV)cavity in diastole then relaxed to the middle only to deviate again into the LV cavity late in diastole after atrial contraction. Insevere cases, the septum bowed into the LV cavity for the full duration of diastole (pan-diastolic motion). We describe howinspiration also helped to characterize the severity of constriction especially in mild to moderate cases. Conclusion: Echocardiography appears a simple tool to help diagnose constriction and grade its severity. Larger studies areneeded to confirm whether the type of wobble motions helps to grade the severity of constrictive pericarditis.
Abstract
Background: Constrictive pericarditis is an uncommon condition that could be easily confused with congestive heart failure. In symptomatic patients, septal “wobble” on echocardiography may be an important sign of constrictive physiology. This studywas planned to investigate the effects of constriction on septal motion as identified by echocardiography. Methods: In this retrospective observational study, nine consecutive patients with constriction underwent carefulechocardiographic analysis of the interventricular septum (IVS) with slow motion 2-dimensional echocardiography andinspiratory manoeuvres. Six patients who had undergone cardiac magnetic resonance imaging underwent similar analysis. Findings were correlated with haemodynamic data in five patients who had undergone cardiac catheterisation studies. Results: In mild cases of constriction a single wobble of the IVS was seen during normal respiration. In more moderate cases adouble motion of the septum (termed “double wobble”) was seen where the septum bowed initially into the left ventricle (LV)cavity in diastole then relaxed to the middle only to deviate again into the LV cavity late in diastole after atrial contraction. Insevere cases, the septum bowed into the LV cavity for the full duration of diastole (pan-diastolic motion). We describe howinspiration also helped to characterize the severity of constriction especially in mild to moderate cases. Conclusion: Echocardiography appears a simple tool to help diagnose constriction and grade its severity. Larger studies areneeded to confirm whether the type of wobble motions helps to grade the severity of constrictive pericarditis.
참고문헌 (9)
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