Differentiating constrictive pericarditis and restrictive cardiomyopathy
- Paul Sorajja, MD
Paul Sorajja, MD
- Associate Professor of Medicine
- Minneapolis Heart Institute
- Brian D Hoit, MD
Brian D Hoit, MD
- Professor of Medicine and Physiology and Biophysics
- Case Western Reserve University and University Hospitals of Cleveland
Constrictive pericarditis is the result of scarring and consequent loss of the normal elasticity of the pericardial sac. This leads to impairment of ventricular filling in mid and late diastole. As a result, the majority of ventricular filling occurs rapidly in early diastole and the ventricular volume does not increase after the end of the early filling period.
Restrictive cardiomyopathy is characterized by a nondilated rigid ventricle, resulting in severe diastolic dysfunction and restrictive filling that produces hemodynamic changes similar to those in constrictive pericarditis.
Constrictive pericarditis and restrictive cardiomyopathy both lead to diastolic heart failure with normal (or near normal) systolic function, and characteristically abnormal ventricular filling that results in similar clinical and hemodynamic features. However, because of their markedly different treatments, differentiating between the two conditions is critical. In some patients, the correct diagnosis may be readily suggested from the history or routine diagnostic testing. In others, however, this differentiation cannot be diagnosed before biopsy or even surgical exploration.
The distinction between constrictive pericarditis and restrictive cardiomyopathy will be reviewed here. The basic aspects of constrictive pericarditis and idiopathic restrictive cardiomyopathy are discussed separately. (See "Constrictive pericarditis" and "Idiopathic restrictive cardiomyopathy".)
PATHOPHYSIOLOGY OF RESPIRATORY EFFECTS
An understanding of ventricular volume constraints and ventricular interaction is key in any discussion of the hemodynamic differences between constrictive pericarditis and restrictive cardiomyopathy.
- Francone M, Dymarkowski S, Kalantzi M, et al. Assessment of ventricular coupling with real-time cine MRI and its value to differentiate constrictive pericarditis from restrictive cardiomyopathy. Eur Radiol 2006; 16:944.
- Hatle LK, Appleton CP, Popp RL. Differentiation of constrictive pericarditis and restrictive cardiomyopathy by Doppler echocardiography. Circulation 1989; 79:357.
- Oh JK, Hatle LK, Seward JB, et al. Diagnostic role of Doppler echocardiography in constrictive pericarditis. J Am Coll Cardiol 1994; 23:154.
- Ling LH, Oh JK, Schaff HV, et al. Constrictive pericarditis in the modern era: evolving clinical spectrum and impact on outcome after pericardiectomy. Circulation 1999; 100:1380.
- Leya FS, Arab D, Joyal D, et al. The efficacy of brain natriuretic peptide levels in differentiating constrictive pericarditis from restrictive cardiomyopathy. J Am Coll Cardiol 2005; 45:1900.
- Babuin L, Alegria JR, Oh JK, et al. Brain natriuretic peptide levels in constrictive pericarditis and restrictive cardiomyopathy. J Am Coll Cardiol 2006; 47:1489.
- Sengupta PP, Krishnamoorthy VK, Abhayaratna WP, et al. Comparison of usefulness of tissue Doppler imaging versus brain natriuretic peptide for differentiation of constrictive pericardial disease from restrictive cardiomyopathy. Am J Cardiol 2008; 102:357.
- Ling LH, Oh JK, Breen JF, et al. Calcific constrictive pericarditis: is it still with us? Ann Intern Med 2000; 132:444.
- Talreja DR, Edwards WD, Danielson GK, et al. Constrictive pericarditis in 26 patients with histologically normal pericardial thickness. Circulation 2003; 108:1852.
- Masui T, Finck S, Higgins CB. Constrictive pericarditis and restrictive cardiomyopathy: evaluation with MR imaging. Radiology 1992; 182:369.
- Rajagopalan N, Garcia MJ, Rodriguez L, et al. Comparison of new Doppler echocardiographic methods to differentiate constrictive pericardial heart disease and restrictive cardiomyopathy. Am J Cardiol 2001; 87:86.
- Ha JW, Oh JK, Ling LH, et al. Annulus paradoxus: transmitral flow velocity to mitral annular velocity ratio is inversely proportional to pulmonary capillary wedge pressure in patients with constrictive pericarditis. Circulation 2001; 104:976.
- Tabata T, Kabbani SS, Murray RD, et al. Difference in the respiratory variation between pulmonary venous and mitral inflow Doppler velocities in patients with constrictive pericarditis with and without atrial fibrillation. J Am Coll Cardiol 2001; 37:1936.
- Boonyaratavej S, Oh JK, Tajik AJ, et al. 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.
- Kaga S, Mikami T, Takamatsu Y, et al. Quantitative and pattern analyses of continuous-wave Doppler-derived pulmonary regurgitant flow velocity for the diagnosis of constrictive pericarditis. J Am Soc Echocardiogr 2014; 27:1223.
- Amaki M, Savino J, Ain DL, et al. Diagnostic concordance of echocardiography and cardiac magnetic resonance-based tissue tracking for differentiating constrictive pericarditis from restrictive cardiomyopathy. Circ Cardiovasc Imaging 2014; 7:819.
- Choi JH, Choi JO, Ryu DR, et al. Mitral and tricuspid annular velocities in constrictive pericarditis and restrictive cardiomyopathy: correlation with pericardial thickness on computed tomography. JACC Cardiovasc Imaging 2011; 4:567.
- Welch TD, Ling LH, Espinosa RE, et al. Echocardiographic diagnosis of constrictive pericarditis: Mayo Clinic criteria. Circ Cardiovasc Imaging 2014; 7:526.
- Palka P, Lange A, Donnelly JE, Nihoyannopoulos P. Differentiation between restrictive cardiomyopathy and constrictive pericarditis by early diastolic doppler myocardial velocity gradient at the posterior wall. Circulation 2000; 102:655.
- Choi EY, Ha JW, Kim JM, et al. Incremental value of combining systolic mitral annular velocity and time difference between mitral inflow and diastolic mitral annular velocity to early diastolic annular velocity for differentiating constrictive pericarditis from restrictive cardiomyopathy. J Am Soc Echocardiogr 2007; 20:738.
- Kusunose K, Dahiya A, Popović ZB, et al. Biventricular mechanics in constrictive pericarditis comparison with restrictive cardiomyopathy and impact of pericardiectomy. Circ Cardiovasc Imaging 2013; 6:399.
- Cheng H, Zhao S, Jiang S, et al. The relative atrial volume ratio and late gadolinium enhancement provide additive information to differentiate constrictive pericarditis from restrictive cardiomyopathy. J Cardiovasc Magn Reson 2011; 13:15.
- Vogelsberg H, Mahrholdt H, Deluigi CC, et al. Cardiovascular magnetic resonance in clinically suspected cardiac amyloidosis: noninvasive imaging compared to endomyocardial biopsy. J Am Coll Cardiol 2008; 51:1022.
- MCHENRY MM, ORD JW, JOHNSTON RR, SHOENER JA. EXERCISE PERFORMANCE AND STROKE VOLUME CHANGES IN TWO PATIENTS WITH CONSTRICTIVE PERICARDITIS. Am Heart J 1965; 70:180.
- Nakhjavan FK, Goldberg H. Hemodynamic effects of catecholamine stimulation in constrictive pericarditis. Circulation 1970; 42:487.
- Tyberg TI, Goodyer AV, Hurst VW 3rd, et al. Left ventricular filling in differentiating restrictive amyloid cardiomyopathy and constrictive pericarditis. Am J Cardiol 1981; 47:791.
- 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.
- HANSEN AT, ESKILDSEN P, GOTZSCHE H. Pressure curves from the right auricle and the right ventricle in chronic constrictive pericarditis. Circulation 1951; 3:881.
- Hirota Y, Kohriyama T, Hayashi T, et al. Idiopathic restrictive cardiomyopathy: differences of left ventricular relaxation and diastolic wave forms from constrictive pericarditis. Am J Cardiol 1983; 52:421.
- Meaney E, Shabetai R, Bhargava V, et al. Cardiac amyloidosis, contrictive pericarditis and restrictive cardiomyopathy. Am J Cardiol 1976; 38:547.
- Hurrell DG, Nishimura RA, Higano ST, et al. Value of dynamic respiratory changes in left and right ventricular pressures for the diagnosis of constrictive pericarditis. Circulation 1996; 93:2007.
- Schoenfeld MH, Supple EW, Dec GW Jr, et al. Restrictive cardiomyopathy versus constrictive pericarditis: role of endomyocardial biopsy in avoiding unnecessary thoracotomy. Circulation 1987; 75:1012.
- Maisch B, Bethge C, Drude L, et al. Pericardioscopy and epicardial biopsy--new diagnostic tools in pericardial and perimyocardial disease. Eur Heart J 1994; 15 Suppl C:68.
- PATHOPHYSIOLOGY OF RESPIRATORY EFFECTS
- HISTORY AND PHYSICAL EXAMINATION
- Physical examination
- NON-INVASIVE TESTING
- Plasma BNP
- Chest radiography
- Pericardial imaging
- Doppler echocardiography
- Tissue Doppler imaging
- Speckle tracking echocardiography (STE)
- Cardiac magnetic resonance (CMR)
- CARDIAC CATHETERIZATION
- SUMMARY AND RECOMMENDATIONS