Constrictive Pericarditis on Echo
Constrictive Pericarditis on Echo Constrictive pericarditis is a condition characterized by the thickening, scarring, and loss of elasticity of the pericardium—the sac surrounding the heart. This pathological process hampers the normal diastolic filling of the heart, leading to signs and symptoms of right-sided heart failure such as edema, ascites, and jugular venous distension. Echocardiography (echo) plays a pivotal role in diagnosing constrictive pericarditis, offering detailed insights into cardiac structure and function that aid clinicians in differentiating it from other causes of heart failure, particularly restrictive cardiomyopathy.
On echocardiography, several hallmark features suggest constrictive pericarditis. One of the primary findings is the abnormal diastolic septal motion, often described as “septal bounce” or “shudder,” which results from the abrupt cessation of ventricular filling due to the rigid pericardium. During early diastole, the interventricular septum shifts paradoxically toward the left ventricle, reflecting ventricular interdependence—a phenomenon where the filling of one ventricle influences the other due to the limited pericardial space.
Another key echocardiographic feature is exaggerated respiratory variation in ventricular filling velocities, especially in mitral and tricuspid inflow patterns observed via Doppler imaging. During inspiration, there is a significant decrease in mitral inflow velocity and a corresponding increase in tricuspid inflow velocity, a reflection of ventricular interdependence that is more pronounced in constrictive pericarditis than in restrictive cardiomyopathy.
Echocardiography also reveals respiratory variation in the collapsibility of the inferior vena cava (IVC), with a marked decrease in IVC diameter during inspiration, indicating elevated right atrial pressures. Additionally, abnormal diastolic flow patterns such as early diastolic septal “dip” and abnormal movement of the ventricular walls can be observed.
The tissue Doppler imaging (TDI) component is particularly useful for differentiation. In constrictive pericarditis, the early diastolic mitral annular velocity (e’) remains pre
served or even increased, unlike in restrictive cardiomyopathy where it is reduced. This preserved or enhanced e’ velocity is known as “annular reversibility,” and it helps distinguish constriction from restrictive disease.
Furthermore, advanced echocardiographic techniques like speckle-tracking strain imaging can reveal reduced myocardial deformation in restrictive cardiomyopathy but usually show preserved myocardial motion in constrictive pericarditis. Sometimes, pericardial thickening or calcification can be directly visualized, although this is less sensitive than cardiac CT or MRI.
In summary, echocardiography provides a comprehensive assessment of the functional and structural alterations caused by constrictive pericarditis. Recognizing the characteristic septal bounce, respiratory variations, and preserved e’ velocities helps clinicians differentiate constrictive pericarditis from other cardiomyopathies, guiding appropriate management strategies, often surgical pericardiectomy.
Early diagnosis via echo is critical because constrictive pericarditis is potentially curable with timely surgical intervention. Combined with clinical findings and other imaging modalities, echocardiography remains a cornerstone in the effective diagnosis and management of this condition.
