Journal of Cardiovascular Imaging

Korean Society of Echocardiography (한국심초음파학회)
권호 표지
DOI QR코드

DOI QR Code

Redefining Effusive-Constrictive Pericarditis with Echocardiography

  • van der Bijl, Pieter (Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital) ;
  • Herbst, Philip (Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital) ;
  • Doubell, Anton F. (Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital)
  • Received : 2016.06.10
  • Accepted : 2016.11.30
  • Published : 2016.12.27
⟨ Previous Next ⟩

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.

Keywords

Acknowledgement

Supported by : Harry Crossley Foundation, Stellenbosch University

References

  1. Hancock EW. A clearer view of effusive-constrictive pericarditis. N Engl J Med 2004;350:435-7. https://doi.org/10.1056/NEJMp038199
  2. Hancock EW. Subacute effusive-constrictive pericarditis. Circulation 1971;43:183-92. https://doi.org/10.1161/01.CIR.43.2.183
  3. Cameron J, Oesterle SN, Baldwin JC, Hancock EW. The etiologic spectrum of constrictive pericarditis. Am Heart J 1987;113(2 Pt 1):354-60. https://doi.org/10.1016/0002-8703(87)90278-X
  4. Sagrista-Sauleda J, Angel J, Sanchez A, Permanyer-Miralda G, Soler-Soler J. Effusive-constrictive pericarditis. N Engl J Med 2004;350:469-75. https://doi.org/10.1056/NEJMoa035630
  5. Ntsekhe M, Matthews K, Syed FF, Deffur A, Badri M, Commerford PJ, Gersh BJ, Wilkinson KA, Wilkinson RJ, Mayosi BM. Prevalence, hemodynamics, and cytokine profile of effusive-constrictive pericarditis in patients with tuberculous pericardial effusion. PLoS One 2013;8:e77532. https://doi.org/10.1371/journal.pone.0077532
  6. Ntsekhe M, Shey Wiysonge C, Commerford PJ, Mayosi BM. The prevalence and outcome of effusive constrictive pericarditis: a systematic review of the literature. Cardiovasc J Afr 2012;23:281-5. https://doi.org/10.5830/CVJA-2011-072
  7. Zagol B, Minderman D, Munir A, D'Cruz I. Effusive constrictive pericarditis: 2D, 3D echocardiography and MRI imaging. Echocardiography 2007;24:1110-4. https://doi.org/10.1111/j.1540-8175.2007.00505.x
  8. Syed FF, Ntsekhe M, Mayosi BM, Oh JK. Effusive-constrictive pericarditis. Heart Fail Rev 2013;18:277-87. https://doi.org/10.1007/s10741-012-9308-0
  9. Oh JK, Tajik AJ, Appleton CP, Hatle LK, Nishimura RA, Seward JB. Preload reduction to unmask the characteristic Doppler features of constrictive pericarditis. A new observation. Circulation 1997;95:796-9. https://doi.org/10.1161/01.CIR.95.4.796
  10. Boonyaratavej S, Oh JK, Tajik AJ, Appleton CP, Seward JB. Comparison of mitral inflow and superior vena cava Doppler velocities in chronic obstructive pulmonary disease and constrictive pericarditis. J Am Coll Cardiol 1998;32:2043-8. https://doi.org/10.1016/S0735-1097(98)00472-0
  11. Dal-Bianco JP, Sengupta PP, Mookadam F, Chandrasekaran K, Tajik AJ, Khandheria BK. Role of echocardiography in the diagnosis of constrictive pericarditis. J Am Soc Echocardiogr 2009;22:24-33; quiz 103-4. https://doi.org/10.1016/j.echo.2008.11.004
  12. Reuter H, Burgess L, van Vuuren W, Doubell A. Diagnosing tuberculous pericarditis. QJM 2006;99:827-39. https://doi.org/10.1093/qjmed/hcl123
  13. Hurrell DG, Nishimura RA, Higano ST, Appleton CP, Danielson GK, Holmes DR Jr, Tajik AJ. Value of dynamic respiratory changes in left and right ventricular pressures for the diagnosis of constrictive pericarditis. Circulation 1996;93:2007-13. https://doi.org/10.1161/01.CIR.93.11.2007
  14. Badri M, Wilson D, Wood R. Effect of highly active antiretroviral therapy on incidence of tuberculosis in South Africa: a cohort study. Lancet 2002;359:2059-64. https://doi.org/10.1016/S0140-6736(02)08904-3
  15. Shabetai R. The pericardium. Boston: Kluwer Academic Publishers;2003.
  16. Nagueh SF, Kopelen HA, Zoghbi WA. Relation of mean right atrial pressure to echocardiographic and Doppler parameters of right atrial and right ventricular function. Circulation 1996;93:1160-9. https://doi.org/10.1161/01.CIR.93.6.1160
  17. Kusunose K, Dahiya A, Popovic ZB, Motoki H, Alraies MC, Zurick AO, Bolen MA, Kwon DH, Flamm SD, Klein AL. Biventricular mechanics in constrictive pericarditis comparison with restrictive cardiomyopathy and impact of pericardiectomy. Circ Cardiovasc Imaging 2013;6:399-406. https://doi.org/10.1161/CIRCIMAGING.112.000078
  18. Talreja DR, Nishimura RA, Oh JK, Holmes DR. Constrictive pericarditis in the modern era: novel criteria for diagnosis in the cardiac catheterization laboratory. J Am Coll Cardiol 2008;51:315-9. https://doi.org/10.1016/j.jacc.2007.09.039

Cited by

  1. Pre- and post-pericardiocentesis echo-Doppler features of effusive-constrictive pericarditis compared with cardiac tamponade and constrictive pericarditis vol.20, pp.3, 2019, https://doi.org/10.1093/ehjci/jey081
  2. Effusive-Constrictive Pericarditis: Doppler Findings vol.21, pp.11, 2016, https://doi.org/10.1007/s11886-019-1243-4
  3. Effusive–constrictive pericarditis in the spectrum of pericardial compressive syndromes vol.107, pp.6, 2016, https://doi.org/10.1136/heartjnl-2020-316664
  4. Subacute effusive-constrictive pericarditis in a patient with COVID-19 vol.14, pp.6, 2021, https://doi.org/10.1136/bcr-2021-242443