Assessment of constrictive pericarditis by Tissue Doppler Imaging and Speckle Tracking Imaging

Purpose. Constrictive pericarditis (CP) is defined by a thickened, adherent, or calcific pericardium that limits myocardial free wall motion. Although normal or exaggerated early diastolic mitral annular velocity provides high specificity for differentiating CP from restrictive cardiomyopathy (RCM), its sensitivity has been shown to be lower. Our purpose was to assess the incremental value of Tissue Doppler Imaging (TDI) and Speckle Tracking Imaging (STI) for differentiation between CP and RCM. Methods. Eleven patients with CP, 8 with RCM, and 12 control subjects were studied. Standard mitral inflow Doppler and tissue Doppler echocardiography were performed. LV TDI annular peak systolic and diastolic velocities (S’, E’) and time difference between onset of mitral inflow and onset of E' (E'-E time) were measured. LV peak systolic longitudinal strain (l) and systolic and diastolic strain rate were obtained in the basal, mid and apical segments of septal and lateral walls in apical 4-chamber view both by TDI and STI. Transverse strain and averaged LV rotation and rotational velocities from the base and apex were also obtained by STI. Results. E' and S' were significantly higher in patients with CP than RCM (8.9 ± 1.5 vs 4.3 ± 1.4 cm/s, and 7.9 ± 1.1 vs 4.3 ± 1.6 cm/s respectively, p < .001). E'-E was significantly shorter in patients with CP (25.6 ± 21.7 vs 56.6 ± 24.7 ms, p < .005). Impairment of longitudinal strain in the lateral wall was shown (25.6 ± 16.7 vs 56.6 ± 21.3%, p < .005) whereas transverse strain values did not change significantly. ROC curves suggested that the thresholds offering an adequate compromise between sensitivity and specificity for detection of CP were -20% for STI-l (AUC 0.86), -23% for TDI-l (AUC 0.81), 32.6 ms for E’-E time (AUC 0.77), and -5.0 cm/sec for TDI-E’ velocity (AUC 0.73). Conclusions. TDI and STI parameters can be helpful to differentiate between CP and RCM by providing incremental diagnostic information to conventional Doppler echocardiography