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European Journal of Echocardiography Advance Access published online on October 24, 2008
European Journal of Echocardiography, doi:10.1093/ejechocard/jen258
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Using mitral ‘annulus reversus’ to diagnose constrictive pericarditis

Christina S. Reuss1, Susan M. Wilansky1, Steven J. Lester1, Joan L. Lusk1, Diane E. Grill2, Jae K. Oh3 and A. Jamil Tajik1,*

1 Division of Cardiovascular Diseases, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
2 Division of Biostatistics, Mayo Clinic, Rochester, MN, USA
3 Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA

Received 27 June 2008; accepted after revision 12 September 2008.

* Corresponding author. E-mail address: jtajik{at}mayo.edu


  Abstract

Aims: To characterize mitral medial and lateral annular velocities in constrictive pericarditis or restrictive cardiomyopathy compared with normal subjects.

Methods and results: Tissue Doppler imaging peak systolic velocity (S'), peak early diastolic annular velocity (e'), and timing difference between mitral early flow and early annular movement were measured in 14 patients with constrictive pericarditis, 10 with restrictive cardiomyopathy, and 17 normal subjects using the apical four-chamber view lateral and medial mitral annulus. In controls, mitral lateral e' velocity was 25% higher than medial e' velocity (13.0 ± 3.1 vs. 10.7 ± 2.8 cm/s; P = 0.02), whereas with constrictive pericarditis, averaged lateral e' velocity was 2% lower than medial e' velocity (10.7 ± 2.5 vs. 11.2 ± 3.1 cm/s; P > 0.05). This relationship represented a reversal of lateral and medial e' velocities compared with normal subjects (P = 0.004). Differences in S', E/e', and timing intervals between normal subjects and patients with constrictive pericarditis were not statistically significant; however, restrictive cardiomyopathy could be distinguished from constrictive pericarditis and controls with all other parameters (S', E/e', medial and lateral e' velocities, and timing interval differences; all P < 0.05).

Conclusion: Practical applications of tissue Doppler imaging for evaluation of possible constrictive pericarditis include reversal of the relationship between lateral and medial e' velocities (i.e. ‘annulus reversus’).

Keywords: Cardiomyopathy; Doppler ultrasound; Echocardiography, adult; Pericardial heart disease


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