Diagnosis of constrictive pericarditis by quantitative tissue Doppler imaging.

OBJECTIVES: To observe the motion of pericardium and myocardium in patients with constrictive pericarditis (CP) and normal subjects using two-dimensional (2D) echocardiography and quantitative tissue Doppler imaging (QTDI), and to investigate the value of this echocardiographic approach in the diagnosis of pericardial adhesion in CP.

BACKGROUND: The relationship of the motion of pericardium and myocardium in CP has not been investigated by QTDI.

METHODS: The motions of pericardium and myocardium and the difference between them were investigated using 2D echocardiography combined with QTDI technique in 20 patients with CP and 20 age- and sex-matched normal subjects. Systolic peak displacements of pericardium (D(1)), outer-layer myocardium (D(2)) and inner-layer myocardium (D(3)) were measured from quantitative tissue displacement curves. The ratios of (D(3)-D(2))/(D(2)-D(1)) were then calculated.

RESULTS: In normal subjects, the motion of myocardium was found to be stronger than that of pericardium, but the motions of outer-layer and inner-layer myocardium were virtually identical. However, in patients with CP, the motion of outer-layer myocardium was significantly reduced approaching that of pericardium, while the motion of inner-layer myocardium was stronger than that of outer-layer myocardium. The ratios of (D(3)-D(2))/(D(2)-D(1)) were significantly higher in patients with CP than those in normal subjects (5.0+/-4.7 vs 0.6+/-0.7, P<0.05).

CONCLUSIONS: Obvious differences exist in the motion of pericardium and myocardium between normal subjects and patients with CP; observations of these differences using 2D echocardiography and QTDI provide a new and sensitive method in the diagnosis of pericardial adhesion in CP.