Strain Reversus: A Diagnostic Regional Myocardial Left Ventricular Longitudinal Strain Pattern in Tuberculous Constrictive Pericarditis on Two-Dimensional Speckle Tracking Echocardiography

Abstract

Background: Tuberculous constrictive pericarditis (CP) is a chronic inflammatory disease by Mycobacterium tuberculosis affecting the pericardium, occurring mainly in developing nations. The aim of this study was to evaluate left atrial (LA) and left ventricular (LV) myocardial mechanics in tuberculous CP using standard two-dimensional (2D) echocardiography and speckle tracking echocardiography (STE). Methods: A prospective observational echocardiographic study of 30 subjects was performed: 15 patients with tuberculous CP and 15 controls. 2D echocardiography, color Doppler imaging, and tissue Doppler imaging (TDI) were performed along with STE to evaluate the LV and LA mechanics. Results: We found that the global circumferential strain (GCS, P = 0.002) and the global longitudinal strain (P = 0.02) were significantly reduced in patients with CP compared with controls. The longitudinal lateral wall strain was significantly reduced (P = 0.001) in CP patients, whereas longitudinal septal strain was not reduced significantly (P = 0.18) in CP patients compared with controls. The longitudinal lateral strain was significantly reduced as compared to the longitudinal septal strain (P = 0.001) within the CP group (strain reversus). Annulus reversus (medial early diastolic mitral annular velocity [e'] > lateral e') by TDI was observed in 11 cases out of 15 in tuberculous CP group, whereas strain reversus (septal strain > lateral strain) was seen in all cases of CP group. The LA reservoir strain showed a statistically significant reduction in CP patients (P = 0.001) compared to controls. Conclusions: “Strain reversus” and reduced GCS are characteristic imaging findings on STE in patients with tuberculous CP and may provide an additional parameter to conventional echocardiography in the diagnosis of tuberculous CP.