This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Akasaka, T. Articles by Yoshikawa, J. Search for Related Content PubMed PubMed Citation Articles by Akasaka, T. Articles by Yoshikawa, J. Pubmed/NCBI databases Medline Plus Health Information Cardiomyopathy

(Circulation. 1997;96:1874-1881.)
© 1997 American Heart Association, Inc.

Articles

Phasic Coronary Flow Characteristics in Patients With Constrictive Pericarditis

Comparison With Restrictive Cardiomyopathy

Takashi Akasaka, MD; Kiyoshi Yoshida, MD; Atushi Yamamuro, MD; Takeshi Hozumi, MD; Tsutomu Takagi, MD; Shigefumi Morioka, MD; ; Junichi Yoshikawa, MD

From the Department of Cardiology (T.A., K.Y., A.Y., T.H., T.T., S.M.), Kobe General Hospital, and the First Department of Internal Medicine (J.Y.), Osaka, Japan.

Correspondence to Takashi Akasaka, MD, Department of Cardiology, Kobe General Hospital, Minatojima-nakamachi 4-6, Chuo-ku, Kobe 650, Japan.

Background Phasic coronary flow characteristics have been reported in patients with aortic valve disease and hypertrophic cardiomyopathy. The purpose of this study was to assess the differences in coronary flow characteristics between patients with constrictive pericarditis and those with restrictive cardiomyopathy.

Methods and Results The study populations consisted of 7 case patients with constrictive pericarditis, 8 with restrictive cardiomyopathy, and 11 control subjects with chest pain and normal coronary arteries. Five minutes after injection of 3 mg of isosorbide dinitrate, phasic coronary flow velocity patterns were analyzed in the proximal segment of the angiographically normal left anterior descending coronary artery at rest using a 0.014-in, 15-MHz Doppler guidewire. Coronary flow reserve was obtained from the ratio of adenosine-induced (0.14 mg · kg^-1 · min^-1 IV) hyperemic/baseline time-averaged peak velocity. Although in case patients with constrictive pericarditis and restrictive cardiomyopathy maximal hyperemic time-averaged peak velocity (21±8 and 31±17 versus 60±19 cm/s, respectively; P<.001) and coronary flow reserve (1.3±0.4 and 1.6±0.6 versus 3.6±0.4, respectively, P<.001) were significantly lower than in control subjects, there were no significant differences in these indexes between the two groups of case patients. Velocity half-time of diastolic flow velocity corrected by , which indicates deceleration of diastolic flow, in the groups of case patients with constrictive pericarditis and restrictive cardiomyopathy was significantly less than that in control subjects (6.2±2.6 and 10.6±1.5 versus 16.9±2.7, respectively; P<.001); this was also significantly smaller in constrictive pericarditis than restrictive cardiomyopathy (P<.001). This index <9.5 could distinguish constrictive pericarditis from restrictive cardiomyopathy with a sensitivity of 86% and a specificity of 88%. Furthermore, time from the beginning of diastole to diastolic peak velocity corrected by indicating acceleration of diastolic flow velocity in constrictive pericarditis was significantly less than that in restrictive cardiomyopathy and control subjects (2.8±1.2 versus 4.8±0.8 and 4.4±0.6, respectively; P<.001).

Conclusions Although coronary flow reserve is limited in both constrictive pericarditis and restrictive cardiomyopathy because of restriction of hyperemic response, rapid acceleration and more rapid deceleration of diastolic flow velocity are more characteristic in constrictive pericarditis than in restrictive cardiomyopathy.

Key Words: pericarditis • cardiomyopathy • diagnosis • coronary flow

This article has been cited by other articles:

				E. I. Skalidis, G. E. Kochiadakis, S. I. Chrysostomakis, N. E. Igoumenidis, E. G. Manios, and P. E. Vardas Effect of Pericardial Pressure on Human Coronary Circulation Chest, March 1, 2000; 117(3): 910 - 912. [Abstract] [Full Text] [PDF]

				C. Caiati, N. Zedda, C. Montaldo, R. Montisci, and S. Iliceto Contrast-enhanced transthoracic second harmonic echo doppler with adenosine: A noninvasive, rapid and effective method for coronary flow reserve assessment J. Am. Coll. Cardiol., July 1, 1999; 34(1): 122 - 130. [Abstract] [Full Text] [PDF]

				T. Hozumi, K. Yoshida, T. Akasaka, Y. Asami, Y. Ogata, T. Takagi, S. Kaji, T. Kawamoto, Y. Ueda, and S. Morioka Noninvasive assessment of coronary flow velocity and coronary flow velocity reserve in the left anterior descending coronary artery by Doppler echocardiography: Comparison with invasive technique J. Am. Coll. Cardiol., November 1, 1998; 32(5): 1251 - 1259. [Abstract] [Full Text] [PDF]