Role of Echocardiography in Diagnosis of Constrictive Pericarditis: a Practical Summary

Abstract

Constrictive pericarditis (CP) is an uncommon diagnosis in the modern day. Clinically, CP and restrictive cardiomyopathy can present in a similar fashion; however, differentiating the two entities is imperative since CP is potentially curable by pericardiectomy. In this manuscript, we aim to summarize echocardiographic characteristics of CP with a focus on parameters discriminating CP from restrictive cardiomyopathy (RCM). Classically, respiration-related interventricular septal shift and variations in mitral inflow and mitral annular velocities have been used to distinguish CP from RCM. Moreover, newer sophisticated echocardiography techniques including myocardial strain imaging by two-dimensional speckle tracking echocardiography (2D STE) have revolutionized our understanding of the myocardial mechanics in CP and RCM. Reduced circumferential strain in CP as well as reduced longitudinal strain in RCM has been shown to provide high sensitivity and specificity to differentiate the two clinical imitators. Echocardiography remains an important modality for diagnosing constrictive pericarditis. Advances in echocardiographic techniques have further improved the diagnostic ability of this imaging modality in diagnosing constriction and differentiating it from other clinically similar entities.