OBJECTIVES: The purpose of this study was to evaluate the ability of a novel cardiac magnetic resonance (CMR) real-time phase contrast (RT-PC) flow measurement technique to reveal the discordant respirophasic changes in mitral and tricuspid valve in flow indicative of the abnormal hemodynamics seen in constrictive pericarditis (CP). BACKGROUND: Definitive diagnosis of CP requires identification of constrictive hemodynamics with or without pericardial thickening. CMR to date has primarily provided morphological assessment of the pericardium. METHODS: Sixteen patients (age 57 ± 13 years) undergoing CMR to assess known or suspected CP and 10 controls underwent RT-PC that acquired simultaneous mitral valve and tricuspid valve inflow velocities over 10 s of unrestricted breathing. The diagnosis of CP was confirmed via clinical history, diagnostic imaging, cardiac catheterization, intraoperative findings, and histopathology. RESULTS: Ten patients had CP, all with increased pericardial thickness (6.2 ± 1.0 mm). RT-PC imaging demonstrated discordant respirophasic changes in atrioventricular valve inflow velocities in all CP patients, with mean ± SD mitral valve and tricuspid valve inflow velocity variation of 46 ± 20% and 60 ± 15%, respectively, compared with 16 ± 8% and 24 ± 11% in patients without CP (p < 0.004 vs. patients with CP for both) and 17 ± 5% and 31 ± 13% in controls (p < 0.001 vs. patients with CP for both). There was no difference in atrioventricular valve inflow velocity variation between patients without CP compared with controls (p > 0.3 for both). Respiratory variation exceeding 25% across the mitral valve yielded a sensitivity of 100%, a specificity of 100%, and an area under the receiver-operating characteristic curve of 1.0 to detect CP physiology. Using a cutoff of 45%, variation of transtricuspid valve velocity had a sensitivity of 90%, a specificity of 88%, and an area under the receiver-operating characteristic curve of 0.98. CONCLUSIONS: Accentuated and discordant respirophasic changes in mitral valve and tricuspid valve inflow velocities characteristic of CP can be identified noninvasively with RT-PC CMR. When incorporated into existing CMR protocols for imaging pericardial morphology, RT-PC CMR provides important hemodynamic evidence with which to make a definite diagnosis of CP.
OBJECTIVES: The purpose of this study was to evaluate the ability of a novel cardiac magnetic resonance (CMR) real-time phase contrast (RT-PC) flow measurement technique to reveal the discordant respirophasic changes in mitral and tricuspid valve in flow indicative of the abnormal hemodynamics seen in constrictive pericarditis (CP). BACKGROUND: Definitive diagnosis of CP requires identification of constrictive hemodynamics with or without pericardial thickening. CMR to date has primarily provided morphological assessment of the pericardium. METHODS: Sixteen patients (age 57 ± 13 years) undergoing CMR to assess known or suspected CP and 10 controls underwent RT-PC that acquired simultaneous mitral valve and tricuspid valve inflow velocities over 10 s of unrestricted breathing. The diagnosis of CP was confirmed via clinical history, diagnostic imaging, cardiac catheterization, intraoperative findings, and histopathology. RESULTS: Ten patients had CP, all with increased pericardial thickness (6.2 ± 1.0 mm). RT-PC imaging demonstrated discordant respirophasic changes in atrioventricular valve inflow velocities in all CP patients, with mean ± SD mitral valve and tricuspid valve inflow velocity variation of 46 ± 20% and 60 ± 15%, respectively, compared with 16 ± 8% and 24 ± 11% in patients without CP (p < 0.004 vs. patients with CP for both) and 17 ± 5% and 31 ± 13% in controls (p < 0.001 vs. patients with CP for both). There was no difference in atrioventricular valve inflow velocity variation between patients without CP compared with controls (p > 0.3 for both). Respiratory variation exceeding 25% across the mitral valve yielded a sensitivity of 100%, a specificity of 100%, and an area under the receiver-operating characteristic curve of 1.0 to detect CP physiology. Using a cutoff of 45%, variation of transtricuspid valve velocity had a sensitivity of 90%, a specificity of 88%, and an area under the receiver-operating characteristic curve of 0.98. CONCLUSIONS: Accentuated and discordant respirophasic changes in mitral valve and tricuspid valve inflow velocities characteristic of CP can be identified noninvasively with RT-PC CMR. When incorporated into existing CMR protocols for imaging pericardial morphology, RT-PC CMR provides important hemodynamic evidence with which to make a definite diagnosis of CP.
Authors: David Verhaert; Ruvin S Gabriel; Douglas Johnston; Bruce W Lytle; Milind Y Desai; Allan L Klein Journal: Circ Cardiovasc Imaging Date: 2010-05 Impact factor: 7.792
Authors: B C McCaughan; H V Schaff; J M Piehler; G K Danielson; T A Orszulak; F J Puga; J R Pluth; D C Connolly; D C McGoon Journal: J Thorac Cardiovasc Surg Date: 1985-03 Impact factor: 5.209
Authors: Deepak R Talreja; William D Edwards; Gordon K Danielson; Hartzell V Schaff; A Jamil Tajik; Henry D Tazelaar; Jerome F Breen; Jae K Oh Journal: Circulation Date: 2003-09-29 Impact factor: 29.690
Authors: J K Oh; L K Hatle; J B Seward; G K Danielson; H V Schaff; G S Reeder; A J Tajik Journal: J Am Coll Cardiol Date: 1994-01 Impact factor: 24.094
Authors: Benedetta Giorgi; Nico R A Mollet; Steven Dymarkowski; Frank E Rademakers; Jan Bogaert Journal: Radiology Date: 2003-06-11 Impact factor: 11.105
Authors: Julius Traber; Lennart Wurche; Matthias A Dieringer; Wolfgang Utz; Florian von Knobelsdorff-Brenkenhoff; Andreas Greiser; Ning Jin; Jeanette Schulz-Menger Journal: Eur Radiol Date: 2015-07-19 Impact factor: 5.315
Authors: Adam Rich; Michael Gregg; Ning Jin; Yingmin Liu; Lee Potter; Orlando Simonetti; Rizwan Ahmad Journal: Magn Reson Med Date: 2019-11-12 Impact factor: 4.668
Authors: Michael A Bolen; Prabhakar Rajiah; Kenya Kusunose; Patrick Collier; Allan Klein; Zoran B Popović; Scott D Flamm Journal: Int J Cardiovasc Imaging Date: 2015-02-12 Impact factor: 2.357
Authors: M Markl; S Schnell; C Wu; E Bollache; K Jarvis; A J Barker; J D Robinson; C K Rigsby Journal: Clin Radiol Date: 2016-03-02 Impact factor: 2.350