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Redefining effusive-constrictive pericarditis with echocardiography
Pieter van der Bijl*, Philip Herbst, Anton Doubell
Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital Division of Cardiology, Department of Medicine
Corresponding Author: Pieter van der Bijl ,Tel: +27 21 938 4400, Email: pieter.vanderbijl@gmail.com
ABSTRACT
Background:
Effusive-constrictive pericarditis (ECP) is traditionally diagnosed by using the expensive and invasive technique of direct pressure measurements in the pericardial space and the right atrium. The aim of this study was to assess the diagnostic role of echocardiography in tuberculous ECP. Methods and
Results:
Intrapericardial and right atrial pressures were measured pre- and post-pericardiocentesis, and right ventricular and left ventricular pressures were measured post-pericardiocentesis in patients with tuberculous pericardial effusions. Echocardiography was performed post-pericardiocentesis. Traditional, pressure-based diagnostic criteria were compared with post-pericardiocentesis systolic discordance and echocardiographic evidence of constriction. Thirty-two patients with tuberculous pericardial disease were included. Sixteen had ventricular discordance (invasively measured), 16 had ECP as measured by intrapericardial and right atrial invasive pressure measurements and 17 had ECP determined echocardiographically. The sensitivity and specificity of pressure-guided measurements (compared with discordance) for the diagnosis of ECP were both 56%. The positive and negative predictive values were both 56%. The sensitivity of echocardiography (compared with discordance) for the diagnosis of ECP was 81% and the specificity 75%, while the positive and the negative predictive values were 76% and 80%, respectively.
Conclusion:
Echocardiography is superior to invasive, pressure-based measurements for the diagnosis of ECP when both these techniques are compared with the gold standard of invasively measured systolic discordance.
Keywords: Effusive-constrictive pericarditis , Tuberculosis, Echocardiography, Hydrostatic pressure measurements
Volume 25, No 3
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