Clinical relevance of Doppler pulmonary venous flow characteristics in constrictive pericarditis

The purpose of this study was to determine the diagnostic valueof Doppler pulmonary venous flow in constrictive pericarditis,as assessed by transoesophageal echocardiography. It has beendemonstrated previously that increased respiratory variationin Doppler pulmonary venous, but not in transmitral flow velocities,can identify patients with constrictive pericarditis, when transoesophagealechocardiography is used. In the present study we compared agroup of 10 patients with constrictive pericarditis and a controlgroup of 15 normal subjects with respect to pulmonary venousand transmitral flow velocities and their respiratory variation.Peak velocities and velocity time integrals of the systolic,early diastolic and late diastolic reversed pulmonary venousflow waves were measured. Peak velocities and velocity timeintegrals of the early and late diastolic transmitral flow waveswere also measured Measurements were made irrespective of therespiratory cycle, at the onset of inspiration and at the onsetof expiration. Values for inspiration and expiration were expressedas percent difference of those obtained irrespective of therespiratory cycle. Peak velocity and velocity time integralof the pulmonary venous systolic and diastolic waves were significantlylower than in normal subjects. Furthermore, the difference betweenpeak velocities of the diastolic wave obtained at the onsetof inspiration and obtained irrespective of the respiratorycycle was significantly larger in constrictive pericarditisthan in the control group (–20% vs –9%, P<0.05).This also applied to the difference between velocity time integralsof the diastolic wave obtained at the onset of inspiration andobtained irrespective of the respiratory cycle (–22% vs–12%, P<0.05). Accordingly, the differences betweenpeak velocities and velocity time integrals of the diastolicwave obtained at the onset of expiration and obtained irrespectiveof the respiratory cycle were significantly larger (19% vs 4%,P<0.05 and 34% vs 8%, P<0.001, respectively). Respiratoryvariation of transmitral flow velocities was less pronounced,only the difference between velocity time integrals of the earlywave obtained at the onset of inspiration and obtained irrespectiveof the respiratory cycle was significantly larger in constrictivepericarditis (–19% vs –7%, P<0.05). In conclusion, in this transoesophageal Doppler echocardiographicstudy, patients with constrictive pericarditis had significantlylower forward pulmonary venous peak velocities and exhibiteda significantly larger respiratory variation in the diastolicflow wave as compared to normal subjects. Respiratory variationof transmitral flow velocities was less pronounced.