Diagnostic value of invasive cardiac catheterization for constrictive pericarditis and restrictive cardiomyopathy

Objective To evaluate the diagnostic value of invasive cardiac catheterization for restrictive cardiomyopathy (RCM) and constrictive pericarditis (CP). Methods Twenty-seven children with CP or RCM hospita-lized in Department of Cardiology, Shanghai Children′s Medical Center, School of Medicine, Shanghai Jiaotong University from February 2002 to December 2015, were selected, including 10 patients who had been surgically documented CP and 17 patients with RCM who underwent cardiac catheterization.Intracardiac pressure waveforms were recorded and all the measurement indexes of pressure of all the patients were analyzed.The changes of cardiac pressure under deep breathing in 9 patients with local anesthesia was recorded. Results There were significant differences in pulmonary artery pressure, difference between left ventricular end-diastolic pressure (LVEDP) and right ventricular end-diastolic pressure (RVEDP), and the ratio of RVEDP/right ventricular systolic pressure between group RCM and group CP [(50.2±12.0) mmHg(1 mmHg=0.133 kPa) vs.(38.1±6.8) mmHg, (7.8±5.5) mmHg vs.(1.8±4.7) mmHg, 0.27±0.10 vs.0.45±0.20, respectively; t=2.912, 2.787, 2.418, all P<0.05]. However, there was overlapping for these criteria, and the predictive sensitivity of any of the criteria was less than 66.7%.In patients with CP, reciprocal changes in the filling between right ventricle and left ventricle occurred during respiration.In patients with RCM, the right ventricle and left ventricle pressures moved concordantly with respiration.The systolic area index was greater in group CP than that in group RCM (1.20±0.03 vs.0.70±0.14), and the difference was significant (t=6.152, P<0.01). The systolic area index had a sensitivity of 100.0% and a predictive accuracy of 100.0% for the identification of patients with surgically proven CP. Conclusions Measurements in catheterization, especially the ratio of right ventricular to left ventricular systolic area during inspiration and expiration is a reliable catheterization criterion for differentiating CP from RCM. Key words: Restrictive cardiomyopathy; Constrictive pericarditis; Catheterization; Hemodynamics