Copyright © 2006, The European Society of Cardiology
Clinical features of mixed physiology of constriction and restriction: Echocardiographic characteristics and clinical outcome
aDepartment of Digestive and Cardiovascular Medicine, The University of Tokushima Graduate School, Tokushima, Japan
bDepartment of Internal Medicine, Division of Cardiology, Second Hospital of the Fujita Health University, Nagoya, Japan
cSection of Cardiovascular Imaging, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA
Received 18 October 2005; received in revised form 22 February 2006; accepted after revision 2 March 2006.
* Corresponding author. Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Desk F-15, Cleveland, OH 44195, USA. Tel.: +1 216 444 3932; fax: +1 216 445 2309. kleina{at}ccf.org
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Abstract |
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Aims An entity of patients with mixed physiology of constriction and restriction has been reported, however, the characteristics of these patients have not been well documented. We evaluated the clinical features and the outcome of these patients.
Methods and results Study subjects consisted of 38 patients (57±14 years, 8 females, 30 males) who were diagnosed as having mixed physiology based on transthoracic and/or transesophageal echocardiography, MRI (or CT), cardiac catheterization, endomyocardial biopsy and/or surgical findings. Prior radiation therapy was the most frequent (50%) cause of mixed physiology followed by coronary artery bypass graft without prior radiation (24%) and heart transplantation (8%). The respiratory variation of peak early diastolic transmitral flow velocity by pulsed Doppler transesophageal echocardiography was 10.7% in patients with sinus rhythm and 18.1% in patients with atrial arrhythmia. Pericardial thickening was noted adjacent to the right-sided chambers in 19 patients, left-sided chambers in 10 patients, or both in 9 patients. All-cause 5-year mortality was 40% and unrelated to age, etiology, left ventricular systolic function and therapeutic course. There was a statistically significant difference (p<0.01) between the survival rates in patients with mixed physiology and in patients with pure constriction (n=125).
Conclusions Due to the high mortality in this disease, discrimination of the entity from the patients with pure constriction is mandatory. Transthoracic and transesophageal echocardiography are helpful noninvasive techniques in the diagnosis and the understanding of the physiology of patients with mixed constriction and restriction.
Keywords: Pericarditis; Survival; Echocardiography; Magnetic resonance imaging
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