The differentiation of restrictive cardiomyopathy from constrictive pericarditis.

The differentiation of restrictive cardiomyopathy from pericardial constriction remains a difficult clinical problem. Although the historical, noninvasive, and hemodynamic and angiographic features discussed here provide poor discriminating value when considered individually, a combination of clues may suggest one diagnosis or the other. Endomyocardial biopsy affords the greatest hope of avoiding unnecessary surgical exploration. Thoracotomy continues, however, to be the gold standard by which to make the distinction, carrying with it significant risk in patients with underlying restrictive cardiomyopathy.