J Cardiovasc Ultrasound.  2016 Dec;24(4):317-323. 10.4250/jcu.2016.24.4.317.

Redefining Effusive-Constrictive Pericarditis with Echocardiography

• van der Bijl P
• Herbst P
• Doubell AF

• KMID: 2364650
• DOI: http://doi.org/10.4250/jcu.2016.24.4.317

Abstract

BACKGROUND
Effusive-constrictive pericarditis (ECP) is traditionally diagnosed by using the expensive and invasive technique of direct pressure measurements in the pericardial space and the right atrium. The aim of this study was to assess the diagnostic role of echocardiography in tuberculous ECP.
METHODS
Intrapericardial and right atrial pressures were measured pre- and post-pericardiocentesis, and right ventricular and left ventricular pressures were measured post-pericardiocentesis in patients with tuberculous pericardial effusions. Echocardiography was performed post-pericardiocentesis. Traditional, pressure-based diagnostic criteria were compared with post-pericardiocentesis systolic discordance and echocardiographic evidence of constriction.
RESULTS
Thirty-two patients with tuberculous pericardial disease were included. Sixteen had ventricular discordance (invasively measured), 16 had ECP as measured by intrapericardial and right atrial invasive pressure measurements and 17 had ECP determined echocardiographically. The sensitivity and specificity of pressure-guided measurements (compared with discordance) for the 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 negative predictive values were 76% and 80%, respectively.
CONCLUSION
Echocardiography shows a better diagnostic performance than invasive, pressure-based measurements for the diagnosis of ECP when both these techniques are compared with the gold standard of invasively measured systolic discordance.

Keyword

Effusive-constrictive pericarditis; Tuberculosis; Echocardiography; Hydrostatic pressure measurements

MeSH Terms

Atrial Pressure
Constriction
Diagnosis
Echocardiography*
Heart Atria
Humans
Pericardial Effusion
Pericarditis*
Pericardium
Sensitivity and Specificity
Tuberculosis
Ventricular Pressure

Figure

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  Fig. 1 Allocation of study subjects. ECP: effusive-constrictive pericarditis, RAP: right atrial pressure, COPD: chronic obstructive pulmonary disease.

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  Fig. 2 A decrease of > 25% in the peak E-wave velocity (as determined by a pulsed-wave Doppler recording at the level of the mitral leaflet tips in an apical four-chamber view) on the first beat after inspiration. Exp: expiration, Insp: inspiration.

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  Fig. 3 Systolic discordance, with a reciprocal change in peak left ventricular and right ventricular pressures during maximum inspiration (the first ejection phase following the diastolic phase with the lowest, early left ventricular pressure). The right ventricular index is the percentage of the maximum, right ventricular systolic pressure (indicated by solid arrow) attained during maximum inspiration (defined as the first ejection phase following the diastolic phase with the lowest, early left ventricular pressure, i.e., the third beat). The right ventricular index is 100%, as the right ventricular pressure, defined as above, is at its maximum (compared with, e.g., the first beat–indicated by a dashed arrow). LV: left ventricle, RV: right ventricle, Insp: inspiration, Exp: expiration.

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  Fig. 4 Right ventricular (RV) index (%) (mean and standard deviation) in those subjects with and without discordance, as measured by intraventricular pressures.

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