Echocardiogram
The American College of Cardiology and the European Society of Cardiology guidelines recommend the use of echocardiography for diagnosis of constrictive pericarditis and any other pericardial disease.
(1)Increased pericardial thickness with or without calcification may be reflected in two-dimensional echocardiography.
(2)The shift of ventricular septum may be observed in CP with a sensitivity of 93%[44].
(3)Comparing with an average person, armored pericardium contributes to the dissociation of intracardiac and intrathoracic pressures, which causes a reduction in mitral early (E) inflow velocities during inspiration.
(4)Due to the high right atrium (RA) pressure, the resistance from hepatic vein to RA increases, and expiration will undoubtedly enlarge the obstruction. So hepatic vein diastolic flow reversal during expiration is a specific (88%) sign of CP.
(5)Tissue Doppler, which may have a preserved or elevated e’, is often used to evaluate diastolic function. Also, we can see the medial e’ velocity is higher than the lateral of the myocardium, which is exactly the opposite of routine, and called ’annulus reverses’[45].
(6)Two-dimensional speckle tracking echocardiography aiming at evaluating myocardial mechanics provide additional diagnostic and clinical information in the context of CP. The typical longitudinal deformation pattern of CP includes preserved septal and reduced longitudinal strain values in left ventricular free wall myocardial segments due to pericardial adhesions, which is different from restrictive cardiomyopathies-where longitudinal strain is usually uniformly reduced, and the values are much lower than CP[46,47].