Table 2.
Differential diagnosis between restrictive cardiomyopathy and constrictive pericarditis.
| Clinical and investigation features | Restrictive cardiomyopathy | Constrictive pericarditis |
|---|---|---|
| History | Systemic disease (e.g., sarcoidosis, hemochromatosis). | Prior history of pericarditis or conditions affecting the pericardium. |
|
| ||
| Physical examination | ± Kussmaul sign, S3 and S4 gallop, murmurs of mitral and tricuspid regurgitation | Pericardial knock |
|
| ||
| Chest X-ray | Atrial dilatation | Pericardial calcification |
|
| ||
| ECG | Low QRS voltages (mainly amyloidosis), conduction disturbances, nonspecific ST abnormalities | Nonspecific ST and T abnormalities, low QRS voltage (<50%) |
|
| ||
| 2D echocardiography | ± Wall and valvular thickening, sparkling myocardium | ± Pericardial thickening, respiratory ventricular septal shift. |
|
| ||
| Doppler echocardiography | Decreased variation in mitral and/or tricuspid inflow E velocity, increased hepatic vein inspiratory diastolic flow reversal, presence of mitral and tricuspid regurgitation | Increased variation in mitral and/or tricuspid inflow E velocity, hepatic vein expiratory diastolic reversal ratio ≥ 0.79 medial e′/lateral e′ ≥ 0.91 (Annulus Reversus) [4] |
|
| ||
| Catheterization hemodynamics | LVEDP – RVEDP ≥ 5 mmHg RVSP ≥ 55 mmHg RVEDP/RVSP ≤ 0.33 |
LVEDP – RVEDP < 5 mmHg RVSP < 55 mmHg RVEDP/RVSP > 0.33 Inspiratory decrease in RAP < 5 mmHg Systolic area index > 1.1 (Ref CP in the modern era) Left ventricular height of rapid filling wave > 7 mmHg |
|
| ||
| CT | Normal pericardium | Thickened/calcified pericardium |
|
| ||
| MRI | Measurement of iron overload, various types of LGE (late gadolinium enhancement) | Thickened pericardium |
|
| ||
| Biopsy | May reveal underlying cause. | Normal myocardium |