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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -2 مورد

Evaluation of suspected restrictive cardiomyopathy or constrictive pericarditis

Evaluation of suspected restrictive cardiomyopathy or constrictive pericarditis
This algorithm describes an approach to patients with suspected RCM or CP based upon history and physical examination findings, generally including elevated JVP and Kussmaul sign. Kussmaul sign is defined as an inspiratory increase (or lack of decline) in JVP during inspiration. However, the JVP may be normal in some patients with RCM, CP, or other causes of heart failure who are volume depleted and/or have early disease. In these patients, JVP findings may be unmasked after carefully monitored volume loading. Refer to UpToDate content on evaluation of JVP.

CMR: cardiovascular magnetic resonance; CP: contrictive pericarditis; CT: computed tomography; E/A: ratio of mitral E and A wave velocities; e': early mitral annular velocity; FDG-PET: 18F-fluorodeoxyglucose positron emission tomography; IVC: inferior vena cava; JVP: jugular venous pressure; LV: left ventricle; RA: right atrium; RCM: restrictive cardiomyopathy; RV: right ventricle; TR: tricuspid regurgitation; TS: tricuspid stenosis.

* TR is another cause of elevated JVP with steep y descent and/or Kussmaul sign. However, presence of TR does not exclude RCM or CP. TR is a frequently a complication or comorbidity in patients with RCM or CP.

¶ Respirophasic interventricular septal shift reflects ventricular interdependence and is characterized by posterior (leftward) movement of the interventricular septum with inspiration and anterior (rightward) movement of the interventricular septum with expiration.

Δ A medial e' ≥8 (or 9) cm/s is used to identify patients in sinus rhythm with respirophasic septal shift who are likely to have CP. When the medial e' is assessed during atrial fibrillation a medial e' ≥11 cm/s is used to identify patients who are likely to have CP.

◊ Choice of further testing depends upon institutional resources and expertise.
References:
  1. Lloyd JW, Anavekar NS, Oh JK, Miranda WR. Multimodality imaging in differentiating constrictive pericarditis from restrictive cardiomyopathy: A comprehensive overview for clinicians and imagers. J Am Soc Echocardiogr 2023; 36:1254.
  2. Diaz-Arocutipa C, Chumbiauca M, Medina HM, et al. Echocardiographic criteria to differentiate constrictive pericarditis from restrictive cardiomyopathy: A meta-analysis. CJC Open 2023; 5:680.
  3. Welch TD, Ling LH, Espinosa RE, et al. Echocardiographic diagnosis of constrictive pericarditis: Mayo Clinic criteria. Circ Cardiovasc Imaging 2014; 7:526.
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