Lww Final The Echo Manual DIGITAL no offer

The Echo Manual

19

CHAPTER 12 PERICARDIAL DISEASES

I WKH FRQWHQW LV SURKLELWHG

8 Q D X WKRUL] H G U H S UR G X F W L R Q R

FIGURE 12-24 A: Algorithm to distinguish restrictive myocardial diseases from constrictive pericarditis. B: Mitral inflow, medial mitral annulus tissue Doppler, hepatic vein Doppler, and strain imaging in constriction ( top ) and restriction ( bottom ).

combination of sensitivity (87%) and specificity (91%) for constrictive pericarditis. The mitral inflow profile almost always shows a restric- tive filling pattern, with or without respiratory variation, in constriction, but the same finding exists in a substantial pro- portion of patients with myocardial disease. Characteristic Doppler recordings are shown in Figure 12-22, and a diag- nostic algorithm based on the Mayo Clinic diagnostic crite- ria is shown in Figure 12-24 (43).

echocardiographic evaluation including respirometer recording. Those five parameters were as follows: 1. respiration-related ventricular septal shift :ROWHUV .OXZHU ,QF 2. variation in mitral inflow E velocity 3. medial mitral annular e ′ velocity 4. ratio of medial mitral annular e ′ to lateral e ′ 5. hepatic vein expiratory diastolic reversal ratio (i.e., dia- stolic reversal velocity/diastolic forward flow velocity during expiration). Three of these variables were independently associated with constrictive pericarditis: 3. hepatic vein expiratory diastolic reversal ratio ≥ 0.8 The presence of a respirophasic ventricular septal shift (most sensitive) in combination with either medial e ′ ≥ 9 cm/s or hepatic vein expiratory diastolic reversal ratio ≥ 0.8 (most specific) corresponded to a desirable &RS\ULJKW ‹ 1. respiration-related ventricular septal shift 2. medial mitral annular e ′ velocity ≥ 9 cm/s

CAUTIONS AND CAVEATS IN THE DIAGNOSIS OF CONSTRICTION

The following precautions deserve our attention to avoid a mistake in the diagnosis of constrictive pericarditis. 1. Respirometer recordings, especially from nasal therm- istors, may have a phase delay up to 1,000 milliseconds and cause confusion interpreting velocity variation. A good rule of thumb is to remember that the lowest

24