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CLINICAL STUDY: DIASTOLIC DYSFUNCTION

Difference in the respiratory variation between pulmonary venous and mitral inflow doppler velocities in patients with constrictive pericarditis with and without atrial fibrillation

^a Cardiovascular Imaging Center, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

Manuscript received September 27, 2000; revised manuscript received February 7, 2001, accepted February 15, 2001.

Reprint requests and correspondence: Dr. Allan L. Klein, Department of Cardiology, Desk F-15, the Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195.
kleina{at}ccf.org

OBJECTIVES

The goal of this study was to evaluate the difference in the respiratory change from expiration to inspiration (%E) between pulsed Doppler mitral inflow (MV) and pulmonary venous flow (PV) velocities in patients with constrictive pericarditis (CP) and to describe the influence of atrial fibrillation (AF).

BACKGROUND

The difference in %E between MV and PV velocities as well as the influence of AF on %E has not been well described.

METHODS

Pulsed-wave Doppler transesophageal echocardiography (TEE) was performed with respiratory monitoring in 31 patients with CP and sinus rhythm (SR) and in 10 patients with CP and AF. The MV early (E) and late diastolic (A) velocities and their velocity time integral (VTI) as well as PV systolic (S) and diastolic (D) velocities and their VTI were measured.

RESULTS

Regardless of the cardiac rhythm: 1) The MV-E velocity and E-VTI as well as PV-D velocity and D-VTI significantly decreased from expiration to inspiration; 2) the %E in PV-D velocity (27% in SR and 35% in AF) and D-VTI (38% in SR and 45% in AF) was significantly greater than that in MV-E velocity (18% in SR and 15% in AF) and E-VTI (21% in SR and 19% in AF), respectively; 3) the PV S/D and S/D-VTI significantly increased from expiration to inspiration.

CONCLUSIONS

A significant respiratory variation was observed in both MV and PV velocities in CP, not only in patients with SR but also in those with AF. Moreover, the %E was greater in the PV velocities than it was in the MV velocities. Evaluation of the %E in the PV velocities using TEE can be a sensitive diagnostic strategy for evaluation of patients with CP, even in patients with AF.

Abbreviations and Acronyms   A = mitral inflow late filling wave   AF = atrial fibrillation   ANOVA = analysis of variance   CP = constrictive pericarditis   D = pulmonary venous diastolic wave   E = mitral inflow early filling wave   MV = mitral inflow   PV = pulmonary venous   S = pulmonary venous systolic wave   TEE = transesophageal echocardiography   VTI = velocity time integral   %E = respiratory change from expiration to inspiration

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