Invasive hemodynamics of constrictive pericarditis

Abstract

Cardiac catheterization and hemodynamic study is the gold standard for the diagnosis of pericardial constriction. Careful interpretation of the hemodynamic data is essential to differentiate it from other diseases with restrictive physiology. In this hemodynamic review we shall briefly discuss the physiologic basis of various hemodynamic changes seen in a patient with constrictive pericarditis.

Constrictive Pericarditis as a Long-term Undetermined Etiology of Ascites and Edema

“…In normal individuals, the ventricular diastolic pressures vary independently and remain unaffected by the other ventricle ( 13 ). Because of the stiff pericardium, which equally limits the expansion of all chambers, the elevation (approximately 20 mmHg) and equalization (within 5 mmHg) of the diastolic pressures at approximately 20 mmHg in all chambers is noted in patients with CP.…”

“…Early diastolic filling of the ventricles is increased, which is represented by a deep rapid filling wave (RFW). An LV RFW of >7 mmHg is reported to show 93% sensitivity and 57% specificity in the diagnosis of CP ( 13 ). The RV systolic pressure is elevated but limited to <50 mmHg ( 13 ).…”

“…An LV RFW of >7 mmHg is reported to show 93% sensitivity and 57% specificity in the diagnosis of CP ( 13 ). The RV systolic pressure is elevated but limited to <50 mmHg ( 13 ). The RV diastolic pressure is usually elevated to more than one-third of the RV systolic pressure ( 13 ).…”

“…The RV systolic pressure is elevated but limited to <50 mmHg ( 13 ). The RV diastolic pressure is usually elevated to more than one-third of the RV systolic pressure ( 13 ). Because of the exaggerated ventricular interdependence, increased RV filling during inspiration shifts the septum toward the left ventricle, leading to decreased LV filling.…”

Septal bounce illustrated on coronary angiogram

“…Septal bounce is a manifestation of exaggerated respirophasic ventricular interdependence, a hallmark of pericardial constriction 1–3. Conventionally, the septal bounce is detected on echocardiogram and MRI.…”