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].