Differentiation of constrictive pericarditis from restrictive cardiomyopathy by computed tomographic imaging (original) (raw)
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Journal of the American College of Cardiology, 1989
Diastolic filling variables were studied in 12 patients with the hemodynamic features of constriction, of whom 5 had restrictive cardiomyopathy, 5 had pericardial constriction and 2 had combined pericardial constriction and restrictive cardiomyopathy. The values were compared with those in 10 normal subjects of comparable age. The filling fractions between 10% and 70% of the diastolic time interval were greater in patients with pericardial constriction than in those with restrictive cardiomyopathy (p < 0.01 between 20% and SO%, p < 0.05 at lo%, 60% and 70%), with no overlap. The filling fractions in patients with pericardial constriction were also greater than those in normal subjects between 10% and 60% of the diastolic time interval. The filling fraction was lower in patients with restrictive cardiomyopathy than in normal subjects at 40% of the diastolic time interval (p < 0.05). The time to peak filling rate in patients with pericardial Patients presenting with the hemodynamic features of constriction (constrictive physiology*) (1) at cardiac catheterization represent an important diagnostic dilemma in cardiology. The differentiation of pericardial constriction from restrictive cardiomyopathy in this situation is critical because management and prognosis of these two conditions are different. The separation of such patients on clinical grounds is difficult, and noninvasive techniques have been unreliable (l-6). Cardiac catheterization and, in particular, right ventricular biopsy can be helpful in establishing the diagnosis
Journal of Clinical Medicine, 2021
To assess the need for additional invasive coronary angiography (CAG) after initial computed tomography coronary angiography (CTCA) in patients awaiting non-coronary cardiac surgery and in patients with cardiomyopathy, heart failure or ventricular arrhythmias, and to determine differences between patients that were referred to initial CTCA or direct CAG, consecutive patients were included between August 2017 and January 2020 and categorized as those referred to initial CTCA (conform protocol), and to direct CAG (non-conform protocol). Out of a total of 415 patients, 78.8% (327 patients, mean age: 57.9 years, 67.3% male) were referred to initial CTCA, of whom 260 patients (79.5%) had no obstructive lesions (<50% DS). A total of 55 patients (16.8%) underwent additional CAG after initial CTCA, which showed coronary lesions of >50% DS in 21 patients (6.3% of 327). Eighty-eight patients (mean age: 66.0 years, 59.1% male) were directly referred to CAG (non-conform protocol). These p...
2014
Bu çalışmada transtorasik ekokardiyografinin (TTE) kalp cerrahisi sonrası gelişen kardiyak tamponad tanısındaki tanısal özgüllüğü ve duyarlılığı değerlendirildi. Ça lış ma pla nı: Ocak 2010 ve Eylül 2012 arasında açık kalp cerrahisi yapılan 2300 hastadan kanama veya kardiyak tamponad nedeniyle revizyon cerrahisi gereken 118'i (39 erkek, 79 kadın; ort. yaş 55.4±15.2 yıl; dağılım 19-80 yıl) retrospektif olarak değerlendirildi. Yetmiş üç hastanın TTE verileri mevcuttu. Transtorasik ekokardiyografinin ve hipotansiyon, oligüri ve metabolik asidoz gibi klinik parametrelerin tanısal özgüllüğü ve duyarlılığı cerrahi doğrulama esas alınarak hesaplandı. Özgüllük ve duyarlılık oranları Cochrane Q testi ve McNemar test kullanılarak karşılaştırıldı. Bul gu lar: İlk ameliyat sonrası geçen sürenin ortalama ve medyan değerleri sırasıyla 12.0±11.7 ve dokuz gün (0-62 gün) idi. Genel mortalite 28 hastada (%38.4) görüldü. Cerrahi olarak kanıtlanmış tamponad hastalarında, TTE %64.5 duyarlılığa sahip iken %92.0'sinde hipotansiyon, %80.6'sında oligüri ve %45.1'inde metabolik asidoz mevcuttu (p<0.001). Cerrahi olarak tamponad olmadığı doğrulanmış hastalarda, TTE %90.9 özgüllüğe sahip iken, %54.5'inde hipotansiyon, %81.8'inde oligüri ve %45.4'ünde metabolik asidoz mevcuttu (p= 0.07). Özgüllük oranları geçen zamanla sabitken duyarlılık oranları yedi günden sonra artma eğilimindeydi. So nuç: Transtorasik ekokardiyografi ameliyat sonrası hemodinamik bozulmanın değerlendirilmesinde önemli bir role sahiptir. Ancak, testin kardiyak tamponad tanısındaki yüksek yanlış negatiflik oranı, yüksek klinik şüphe varlığında zaman kaybının önlenmesi için akılda tutulmalıdır. Anah tar söz cük ler: Ekokardiyografi; duyarlılık; özgüllük; tamponad. Background:This study aims to evaluate the diagnostic specificity and sensitivity of transthoracic echocardiography (TTE) for the diagnosis of cardiac tamponade after cardiac surgery. Methods: Of 2,300 patients who underwent open heart surgery between January 2010 and September 2012, 118 (39 males, 79 females; mean age: 55.4±15.2 years; range 19 to 80 years) who required a revision surgery for bleeding and/or cardiac tamponade were retrospectively analyzed. Data of TTE were available in 73 patients. Diagnostic specificity and sensitivity of the TTE and clinical parameters including hypotension, oliguria, and metabolic acidosis were estimated with respect to surgical confirmation. Sensitivity and specifity rates were compared using the Cochrane Q test and McNemar test. Results: The mean and median time from the first operation were 12.0±11.7 and nine days, respectively (0 to 62 days). Overall mortality occurred in 28 patients (38.4%). Among patients with surgically confirmed tamponade, TTE showed 64.5% sensitivity, whereas hypotension was present in 92.0%, oliguria in 80.6% and metabolic acidosis in 45.1% (p<0.001). Among patients with unconfirmed tamponade, TTE showed 90.9% specificity, whereas hypotension was present in 54.5% patients, oliguria in 81.8% and metabolic acidosis in 45.4% (p= 0.07). Specificity rates showed constancy with time, while sensitivity rates tended to increase after seven days. Conclusion:Transthoracic echocardiography plays an important role in the evaluation of postoperative hemodynamic impairment. However, its high false negativity rate for diagnosis of cardiac tamponade should be kept in mind to prevent further delay in patients with high clinical suspicion.
European Heart Journal, 2008
As a consequence of improved technology, there is growing clinical interest in the use of multi-detector row computed tomography (MDCT) for non-invasive coronary angiography. Indeed, the accuracy of MDCT to detect or exclude coronary artery stenoses has been high in many published studies. This report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT (WG 5) of the European Society of Cardiology and the European Council of Nuclear Cardiology summarizes the present state of cardiac CT technology, as well as the currently available data concerning its accuracy and applicability in certain clinical situations. Besides coronary CT angiography, the use of CT for the assessment of cardiac morphology and function, evaluation of perfusion and viability, and analysis of heart valves is discussed. In addition, recommendations for clinical applications of cardiac CT imaging are given and limitations of the technique are described.
Doppler echocardiography and hemodynamic findings in localized pericardial constriction
American Heart Journal, 1996
Thomas et al. 599 REFERENCES 1. Nelson RM, Jenson CB, Smoot WM. Pericardia] tamponade following open heart surgery. J Thorac Cardiovasc Surg 1969;58:510-6. 2. Endelman RM, Spencer FC, Reed GE, Tice DA. Cardiac tamponade following open heart surgery. Circulation 1970;41(suppl 42):165-71. 3. D'Cruz IA, Kensey IZ~ Campbell C, Replogle R, Jain M. Two-dimensional echocardiography in cardiac tamponade occurring after cardiac surgery. J Am Coll Cardiol 1985;5:1250-2. 4. Reichert CLA, Visser CA, Koolen JJ, vd Brink RBA, van Wezel HB, Meyne NG, Dunning AJ. Transesophageal echocardiography in hypotensive patients after cardiac operations. J Thorac Cardiovasc Sttrg 1992;104:321-6. 5. Kochar GS, Jacobs LE, Kotler MN. Right atrial compression in postoperative cardiac patients: detection by transesophageal echocardiography. J Am Coll Cardiol 1990;16:511-6. 6. Chuttani K, Tischler MD, Pandian NG, Lee RT, Monhanty PK. Diagnosis of cardiac tamponade after cardiac surgery: relative value of clinical, echocardiographic, and hemodynamic signs. A~ HEART J 1994; 127:913-8.
The American Journal of Cardiology, 2014
The ratio of early transmitral flow velocity (E) to mitral annular velocity (E 0 ) is considered a predictor of pulmonary capillary wedge pressure (PCWP). In a previous small study, the paradoxical relation between PCWP and E/E 0 ratio has been described in patients with constrictive pericarditis (CP). We sought to test this paradoxical relation in a larger cohort. We retrospectively identified 49 patients with surgically confirmed CP (40 men; mean age 61 -10 years) who underwent right-sided cardiac catheterization with PCWP measurement, preceded by an echocardiographic study. Of these, 48 patients underwent either computed tomography or magnetic resonance imaging to measure pericardial thickness on the lateral side of the left ventricular wall. Mean interval time between echocardiogram and right-sided cardiac catheterization was 1.5 -3.8 days. There were no significant correlations between mean, medial, or lateral E/E 0 and PCWP (r [ L0.17, 95% confidence interval [CI] L0.43 to L0.12; r [ L0.17, 95% CI L0.43 to L0.12; and r [ L0.12, 95% CI L0.39 to L0.17, respectively). Similarly, there was no correlation between mean E/E 0 and brain natriuretic peptide (Spearman r [ L0.17, p [ NS). Patients with increased pericardial thickness (defined as >4 mm) had both lower lateral peak systolic annular velocity (S 0 ) and lower lateral S 0 integral (7.8 -2.4 vs 9.6 -2.4, p [ 0.02 and 13.2 -4.2 vs 15.9 -4.7, p [ 0.04, respectively). In patients with CP, there were no correlations between septal, lateral, or mean E/E 0 and PCWP. In conclusion, E/E 0 is not predictive of filling pressures in patients with CP, and perhaps the "annulus paradoxus" phenomenon should be revisited. The relation between the mitral annular velocity and thickness of the parietal pericardium may affect this phenomenon. Ó 2014 Elsevier Inc. All rights reserved. (Am J Cardiol 2014;113:1911e1916) Constrictive pericarditis (CP) is characterized by impedance to diastolic filling caused by the external constraints of fibrotic or inflamed pericardium. 1,2 Pericardiectomy is generally the definitive treatment in patients refractory to medical treatment. 3 Although patients still commonly undergo cardiac catheterization before surgical intervention to ascertain the severity of CP, 4 the combination of multimodal noninvasive imaging methods of echocardiography, 5 computed tomography (CT), and cardiac magnetic resonance imaging (MRI) can be used to give more insight into this complex diagnosis. 6 Diagnosis of CP is challenging as it necessitates the integration of seemingly disparate changes in myocardial function and blood flow velocities into the unifying diagnosis of CP. In addition, noninvasive imaging methods lack the accuracy of intracavitary pressure estimation. The most commonly used method of echocardiographic estimation of left ventricular (LV) filling pressure (LVFP) is the ratio of transmitral flow velocity (E) to tissue Doppler velocity of the mitral annulus (E 0 ; i.e., E/E 0 ). Although increased E/E 0 ratio appears to correlate with increased LVFP in many disease states because of a decreased E 0 , 7 it seems to be less accurate in patients with advanced decompensated heart failure or LV hypertrophy. 8,9 Furthermore, patients with CP often show preserved annular motion and therefore preserved E 0 despite severe impairment of LV filling, 10e12 thus making the E/E 0 ratio less accurate. Ha et al 7 showed in a small cohort of patients with CP (n ¼ 10) that there is a paradoxical relation between LVFP and E/E 0 ratio (r ¼ À0.74, p ¼ 0.014) because of a preserved E 0 . However, given the small number of patients in this study, and the heterogeneous nature of CP, we sought to investigate whether these findings could be reproduced in a larger cohort of patients with surgically confirmed CP.
Cardiac computed tomography: Diagnostic utility and integration in clinical practice
Clinical Cardiology, 2009
Cardiac applications of computed tomography (CT) is a rapidly growing diagnostic area because of the ability to visualize plaque burden (coronary artery calcification [CAC]) and luminal obstruction (computed tomographic angiography [CTA]) noninvasively. Coronary artery calcification has been validated in over 1 ,OOO studies over the last 20 years, primarily with electron beam tomography. Studies demonstrate several indications that could aid physicians in the management of symptomatic and asymptomatic patients. Determining that a symptomatic patient has no CAC is associated with both a lower risk of an abnormal nuclear study and angiographic obstruction. The ability to detect subclinical atherosclerosis (CAC) with minimal radiation and no contrast makes this an attractive method for risk stratification. New studies demonstrate a 10-fold risk of cardiovascular events with increasing amounts of coronary calcification. The invasive nature, expense, and risk resulting from invasive angiography have been instrumental in encouraging the development of new diagnostic methods that allow the coronary arteries to be visualized noninvasively. Multislice CT, with its advanced spatial and temporal resolution, has opened up new possibilities in the imaging of the heart and major vessels of the chest, including the coronary arteries. The last decade has seen great strides in the field of cardiac imaging, particularly in the ability to visualize the coronary lumen with sufficient diagnostic accuracy. Possessing that qualification, CTA is now being used increasingly in clinical practice. As a result of having high spatial and improved temporal resolutions, this imaging modality not only allows branches of the coronary artery to be evaluated, but also allows simultaneous analysis of other cardiac structures, making it extremely useful for other cardiac applications. This paper reviews the diagnostic utility and limitations of cardiac CT and how it could be integrated into clinical practice.
Accuracy of Trans-thoracic Echocardiograpy as a pericardial diseases Diagnostic Tool
A prospective comparison of pre-operative trans-thoracic echocardiographic findings with intra-operative findings of 17 patients operated on for pericardial diseases showed excellent correlation for pericardial calcification and adhesion, and for myo-cardial atrophy, and good correlation for pericardial thickening, constriction and effusion respectively. This excellent correlation identified high-risk cases that should have heart-lung machine kept on the stand-by during operation of peri-cardiectomy in event of iatrogenic cardiac chamber laceration.