Pre- and post-pericardiocentesis echo-Doppler features of effusive-constrictive pericarditis compared with cardiac tamponade and constrictive pericarditis

• Published in: European heart journal cardiovascular imaging 2019-03, Vol.20 (3), p.298-306
• Main Authors: Miranda, William R, Newman, Darrell B, Sinak, Lawrence J, Espinosa, Raul E, Anavekar, Nandan S, Goel, Kashish, Oh, Jae K
• Format: Article
• Language: English
• Subjects: Academic Medical Centers; Aged; Cardiac Tamponade - diagnostic imaging; Cardiac Tamponade - physiopathology; Cardiac Tamponade - surgery; Cohort Studies; Echocardiography, Doppler - methods; Female; Humans; Male; Middle Aged; Pericardiectomy - methods; Pericardiocentesis - methods; Pericarditis, Constrictive - diagnostic imaging; Pericarditis, Constrictive - physiopathology; Pericarditis, Constrictive - surgery; Postoperative Care - methods; Preoperative Care; Prognosis; Retrospective Studies; Risk Assessment; Statistics, Nonparametric; Treatment Outcome
• ISSN: 2047-2404; 2047-2412
• DOI: 10.1093/ehjci/jey081

Abstract Aims To review 2D and Doppler findings in patients diagnosed with effusive-constrictive pericarditis (ECP) and compare these to patients with cardiac tamponade and patients with surgically-proven constrictive pericarditis (CP). Methods and results We identified 22 patients diagnosed with ECP at Mayo Clinic, MN, USA between 2002 and 2016 who had persistent elevation of jugular venous pressure post-pericardiocentesis. We compared them to 30 patients with CP and 30 patients with cardiac tamponade who had normalization of venous pressure post-pericardiocentesis. All patients were in sinus rhythm. Mean age was 57 ± 18 years in the ECP group; 36% were females. Most ECP and cardiac tamponade cases were idiopathic (41% and 33%, respectively). Prior to pericardiocentesis, medial and lateral e′ velocities were higher in ECP compared with tamponade; both ECP and tamponade patients had markedly decreased hepatic vein diastolic forward flow velocities. Inspiratory and expiratory mitral E/A ratios were higher in ECP compared with tamponade, but lower than those observed in CP. Post-pericardiocentesis, hepatic vein diastolic forward flow velocities increased in both ECP and tamponade. Hepatic vein diastolic reversal velocities decreased in tamponade but were unchanged in ECP. During median follow-up of 481 days, three patients required pericardiectomy for CP; they were all in the ECP group (14% of ECP cases). Conclusion ECP may have unique echo-Doppler features that distinguish it from both CP and tamponade. Our findings suggest that ECP could be diagnosed by echocardiography even prior to pericardiocentesis. ECP appears to have a good prognosis, particularly in patients presenting acutely.