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(Circulation. 1997;95:796-799.)
© 1997 American Heart Association, Inc.

Articles

Preload Reduction to Unmask the Characteristic Doppler Features of Constrictive Pericarditis

A New Observation

Jae K. Oh, MD; A. Jamil Tajik, MD; Christopher P. Appleton, MD; Liv K. Hatle, MD; Rick A. Nishimura, MD; James B. Seward, MD

the Division of Cardiovascular Diseases and Internal Medicine (J.K.O., A.J.T., R.A.N., J.B.S.), Mayo Clinic and Mayo Foundation, Rochester, Minn; Division of Cardiovascular Diseases (C.P.A.), Mayo Clinic, Scottsdale, Ariz; and Department of Clinical Physiology (L.K.H.), Linkoping, Sweden.

Background Respiratory variation of 25% in mitral E velocity is a characteristic Doppler echocardiographic feature in constrictive pericarditis. However, a subset of patients with constriction do not exhibit the typical respiratory change, most likely because of marked increase in the left atrial pressure, and preload reduction may unmask the respiratory variation.

Methods and Results In 12 patients with surgically confirmed constrictive pericarditis who had <25% respiratory variation in mitral E velocity during an initial preoperative examination, the Doppler study was repeated after an attempt to decrease left ventricular filling pressure. At baseline, mean mitral E velocity was similar after inspiration and expiration (0.81±0.24 and 0.84±0.21 m/s, respectively). On repeat Doppler examination, with the patient in a head-up tilt or sitting position, the decrease in mitral E velocity with inspiration (0.61±0.13 m/s) was significant (P<.004), whereas it did not change significantly with expiration. The mean percent respiratory change in E velocity was 5±7% at baseline and 32±28% with preload reduction. Eight (75%) of the 12 patients developed respiratory variation of 25%.

Conclusions When the respiratory variation in Doppler mitral E velocity is blunted or absent during the evaluation of suspected constrictive pericarditis, repeat Doppler recording of mitral flow velocities after maneuvers to decrease preload is recommended to unmask the characteristic respiratory variation in mitral E velocity.

Key Words: blood flow • echocardiography • pericarditis • respiration

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