From stored digital transthoracic echocardiographic still images, we remeasured all parameters independently of each other with electronic brake calipers in the ProSolv CV Analyzer 3.0 viewer (ProSolv CardioVascular, Indianapolis, Indiana). The maximum mitral entry rate was measured in early (E) and late (A) diastoles in cm/s using pulsed Doppler. The velocities of the crest ring were measured from the four-chamber apical view to the ring-shaped crest systole (S′), the early diastole (e′) and the late diastole (a′) in cm/s of the lateral and median meristal ring. The moment of ring movement and mitral flow was determined by measuring the time (ms) between the beginning of the QRS and the beginning of the ring-shaped movement or the beginning of the E-wave. Pulsed wave Doppler was performed in patients with constrictive pericarditis with simultaneous recordings of the nasal respirator. 2 Different train speeds from 25 to 100 mm/s were used. Doppler velocity analysis was performed on the first beat immediately after the onset of inhalation and exhalation. In addition, in patients with constrictive pericarditis, we averaged data from 5 to 10 strokes throughout the respiratory cycle and reported them as an average parameter. Average e′ velocity throughout the respiratory cycle was used to minimize the potential respirophasic influence of exercise on e′ velocity in patients with constriction. 18 (78%) of patients with constrictive disease had a paradoxical excursion of the mitral valve ring. The average ring-shaped excursion difference was -0.88 (-5.6 to 3.57). Background – Early diastolic mitral ring (E′) is reduced in patients with diastolic dysfunction and increased filling pressure. Since the early rate of transmitral influx (E) gradually increases with higher filling pressures, E/E′ has been shown to have a strong positive relationship with pulmonary capillary pressure (PCWP) and left ventricular enddiastolic pressure.
However, previous studies have mainly focused on patients without pericardimatoma. In constrictive pericarditis (PC), E′ is not reduced despite increased filling pressure. This study investigated the relationship between E/E′ and PCWP in patients with CP. Methods and outcomes – We examined 10 patients (8 men; Average age, 64±7 years) with surgically confirmed PC. Doppler echocardiography was performed to measure early and late diastolic transtransporal flow rates. Tissue Doppler echocardiography was performed to measure E′. PCWP was measured by right cardiac catheterization. All patients were in sinus rhythm. The means E and E′ were 91±15 cm/s and E′, respectively. 11 ±4 cm/s. The mean PCWP was 25±.6 mm Hg. E′ Positively correlated with PCWP (r = 0.69, P = 0.027).
There was a significant inverse correlation between E/E′ and PCWP (r =-0.74, P = 0.014). Despite high left ventricular filling pressures, E/E′ (mean 9±4) was <15 in all but 1 patients. Conclusions – Paradox of positive correlation between E/E′ and PCWP in patients with myocardial disease, an inverse relationship was found in patients with CP. It can be difficult to distinguish between constrictive pericarditis and restrictive cardiomyopathy. In normal subjects and many heart diseases, the lateral mitral ancule shows more longitudinal output than the medial output. This is due to the presence of more longitudinal fibers and lubrication by the pericardium. Annulus paradoxus is a term used to define the reversal of this phenomenon due to pericardial attachment, and has been widely reported as a specific marker of constrictive pericarditis in echocardiography using tissue Doppler imaging (DT). TDI is an impulse wave Doppler technique and has limitations due to aliasing and query angle.
We define another way to demonstrate this phenomenon on CMR, which provides additive diagnostic performance through better spatial resolution. Background: Early diastolic mitral ring (E`) is reduced in patients with diastolic dysfunction and increased filling pressure. Since the transmissional input velocity (E) gradually increases with higher filling pressures, E/E` has been shown to have a strong positive relationship with pulmonary capillary pressure (PCWP) and left ventricular enddiastolic pressure. However, previous studies have mainly focused on patients without pericardimatoma. In constrictive pericarditis (PC), E` is not reduced despite increased filling pressure. This study examined the relationship between E/E` and PCWP in patients with CP. Tissue Doppler imaging of systolic velocity (S′), early diastolic ring velocity (e′) and temporal difference between early mitral flow and early annular movement was measured in 14 patients with constrictive pericarditis, 10 with restrictive cardiomyopathy and 17 normal subjects using the lateral and median mitral ring with four apical chambers.