Pericardial thickness measured with transesophageal echocardiography: feasibility and potential clinical usefulness

Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.

OBJECTIVES: This study assessed the reliability of transesophageal echocardiographic measurements of pericardial thickness and the potential diagnostic usefulness of this technique. BACKGROUND: Transthoracic echocardiography cannot reliably detect thickened pericardium. The superior resolution achieved with transesophageal echocardiography should allow better pericardial definition. METHODS: Pericardial thickness measured at 26 locations in 11 patients with constrictive pericarditis who underwent intraoperative transesophageal echocardiography was compared with pericardial thickness measured with electron beam computed tomography. Intraobserver and interobserver variabilities were determined. Pericardial thickness was then measured in 21 normal subjects. With these values as a guide, two observers reviewed 37 transesophageal echocardiographic studies to determine whether echocardiographic measurement of pericardial thickness could be used to distinguish diseased from normal pericardium. RESULTS: The correlation between echocardiographic and computed tomographic measurements (r > or = 0.95, SE < or = 0.06 mm, p < 0.0001) was excellent. The +/-2 SD limits of agreement were +/-1.0 mm or less for pericardial thickness < 5.5 mm and +/-2.0 mm or less for the entire range of thicknesses. Intraobserver and interobserver agreements were good. Mean normal pericardial thickness was 1.2 +/- 0.8 mm (+/-2 SD) and did not exceed 2.5 mm. Pericardial thickness > or = 3 mm on transesophageal echocardiography was 95% sensitive and 86% specific for the detection of thickened pericardium. CONCLUSIONS: Measurement of pericardial thickness with transesophageal echocardiography is reproducible and should be a valuable adjunct in assessing constrictive pericarditis.

This article has been cited by other articles:

				P. Thavendiranathan, D. Verhaert, M. C. Walls, J. A. Bender, S. Rajagopalan, Y.-C. Chung, O. P. Simonetti, and S. V. Raman Simultaneous Right and Left Heart Real-Time, Free-Breathing CMR Flow Quantification Identifies Constrictive Physiology J. Am. Coll. Cardiol. Img., January 1, 2012; 5(1): 15 - 24. [Abstract] [Full Text] [PDF]

				J. K. Oh, S.-A. Chang, Y.-H. Choe, and P. M. Young CMR Imaging for Diastolic Hemodynamic Assessment: Fantasy or Reality? J. Am. Coll. Cardiol. Img., January 1, 2012; 5(1): 25 - 27. [Full Text] [PDF]

				K. Yared, A. L. Baggish, M. H. Picard, U. Hoffmann, and J. Hung Multimodality Imaging of Pericardial Diseases J. Am. Coll. Cardiol. Img., June 1, 2010; 3(6): 650 - 660. [Abstract] [Full Text] [PDF]

				J. S. Sun, K. J. Park, and D. K. Kang CT Findings in Patients With Pericardial Effusion: Differentiation of Malignant and Benign Disease Am. J. Roentgenol., June 1, 2010; 194(6): W489 - W494. [Abstract] [Full Text] [PDF]

				M. Schwefer, R. Aschenbach, J. Heidemann, C. Mey, and H. Lapp Constrictive pericarditis, still a diagnostic challenge: comprehensive review of clinical management Eur J Cardiothorac Surg, September 1, 2009; 36(3): 502 - 510. [Abstract] [Full Text] [PDF]

				M. Enriquez-Sarano, V. T. Nkomo, and H. Michelena Principles and Practice of Echocardiography in Cardiac Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 315 - 348. [Full Text]

				W. C. Little and G. L. Freeman Pericardial Disease Circulation, March 28, 2006; 113(12): 1622 - 1632. [Full Text] [PDF]

				Task Force members, B. Maisch, P. M. Seferovic, A. D. Ristic, R. Erbel, R. Rienmuller, Y. Adler, W. Z. Tomkowski, G. Thiene, M. H. Yacoub, et al. Guidelines on the Diagnosis and Management of Pericardial Diseases Executive Summary: The Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology Eur. Heart J., April 1, 2004; 25(7): 587 - 610. [Full Text] [PDF]

				D. R. Talreja, W. D. Edwards, G. K. Danielson, H. V. Schaff, A. J. Tajik, H. D. Tazelaar, J. F. Breen, and J. K. Oh Constrictive Pericarditis in 26 Patients With Histologically Normal Pericardial Thickness Circulation, October 14, 2003; 108(15): 1852 - 1857. [Abstract] [Full Text] [PDF]

				Z. J. Wang, G. P. Reddy, M. B. Gotway, B. M. Yeh, S. W. Hetts, and C. B. Higgins CT and MR Imaging of Pericardial Disease RadioGraphics, October 1, 2003; 23(90001): S167 - 180. [Abstract] [Full Text] [PDF]

				R A Nishimura Constrictive pericarditis in the modern era: a diagnostic dilemma Heart, December 1, 2001; 86(6): 619 - 623. [Full Text] [PDF]