Speckle tracking echocardiography in the assessment of constrictive pericarditis.

Background: The aim of the present study was to assess the incremental value of Speckle Tracking Echocardiography (STE) for differentiation between CP and RCM. Although normal or exaggerated early diastolic mitral annular velocity provides high specificity for differentiating constrictive pericarditis (CP) from restrictive cardiomyopathy (RCM), its sensitivity has been shown to be lower. Methods: Twelve patients with CP, 8 with RCM, and 12 healthy controls were studied. Standard mitral inflow Doppler and tissue Doppler echocardiography (TDI) were performed. LV TDI annular peak systolic and diastolic velocities (S’, E’) and time difference between onset of mitral inflow (E velocity) and onset of E' (E'-E time) were measured. LV longitudinal strain and systolic and diastolic strain rate were obtained in the basal, mid and apical segments of septal and lateral walls in apical 4-chamber view both by STE. Circumferential and radial strain and averaged LV rotation and rotational velocities from the base and apex were also obtained by STE. Results: E' and S' were significantly higher in patients with CP than RCM (9.1 ± 1.4 vs 4.4 ± 1.6cm/s, and 7.8 ± 1.2 vs 4.2 ± 1.4cm/s respectively, p <0.001). E'-E was significantly shorter in patients with CP (25.8 ± 21.6 vs 56.5 ± 24.4ms, p <0.005). Impairment of longitudinal strain in the antero-lateral wall (ALWLS) was shown in CP patients compared to controls (-14.2 ± 2.9 vs - 20.1 ± 2.8%, p<0.001) whereas circumferential and radial strain values did not change significantly. ROC curves suggested that the thresholds offering an adequate compromise between sensitivity and specificity for detection of CP were -15.2% for ALWLS (AUC 0.87), 32.8 ms for E’-E time (AUC 0.78), and -5.1 cm/sec for E’ velocity (AUC 0.72). Conclusions: STE indices provide incremental diagnostic information to conventional Doppler echocardiography and can be helpful to differentiate between CP and RCM.