- Typically affected region is the posterior LV wall (or inferolateral) showing reduces strain in these regions
- By definition, the longitudinal septal strain is preserved resulting in only a moderate reduction of global longitudinal strain (GLS) of approximately -16%
- Longitudinal strain in on the epicardial side is reduced more compared to the endocardium
- Radial strain, circumferential strain, and twist / torsion are also moderately reduced
- After pericardiectomy, longitudinal strain shows a partial normalization on short term and a complete normalisation at 12 months
- Sengupta et al, Disparate Patterns of Left Ventricular Mechanics Differentiate Constrictive Pericarditis From Restrictive Cardiomyopathy. (J Am Coll Cardiol Img 2008;1:29–38)
First study to investigate the LV myocardial mechanisms by deformation imaging on ultrasound. Included 26 patients with constructive pericarditis. Main findings were a reduced circumferential strain (-18% vs -27% in controls), torsion (7degrees twist vs 23degrees in controls), and early diastolic untwisting veleocity. Longitudinal strain was not affected (compared to control subjects). Interestingly, this did not normalize after pericardiectomy.
- Leitman et al. Speckle Tracking Imaging in Acute Inflammatory Pericardial Diseases (Echocardiography 2011;28:548-555)
38 Patients with an acute perimyocarditis (most showed regional wall motion abnormalities postolateral). Disease affected the midmyocardial and pericardial layer (seen on MRI). Both longitudinal strain and twist angle were reduced compared to controls (also in those with a preserved LVEF), this resorted to normal at follow up imaging. This study also evaluate longitinal strain in three layers, showing a reduction in all layers, most pronounced in the longitudinal strain of the epicardial layer (compared to the endocardial layer)
- Leitman et al.: Left ventricular function in acute inflammatory peri-myocardial diseases – new insights and long-term follow-up. Cardiovascular Ultrasound 2012 10:42.
- Kusunose et al. Biventricular Mechanics in Constrictive Pericarditis Comparison With Restrictive Cardiomyopathy and Impact of Pericardiectomy. Circ Cardiovasc Imaging. 2013;6:399-406.)
Study including patients with restrictive CMP and constrictive pericarditis (n=52). Those with a constrictive pericarditis showed educed longitudinal strain in the free wall of the RV and LV compared to controls and restrictive CMP (expressed as a free wall / septum ratio). There was a significant inverse correlation between pericardial thickness (measured on MRI) and respective ventricular strains. Pericardectomy leads to systolic strain improvement
- Amaki et al. Diagnostic Concordance of Echocardiography and Cardiac Magnetic Resonance–Based Tissue Tracking for Differentiating Constrictive Pericarditis From Restrictive Cardiomyopathy Circ Cardiovasc Imaging. 2014;7:819-827.
- Negishi et al. Pericardiectomy is Associated with Improvement in Longitudinal Displacement of Left Ventricular Free Wall Due to Increased Counterclockwise Septal-to-Lateral Rotational Displacement J Am Soc Echocardiogr 2015;28:1204-13.
- Li et al. Long-term effects of pericardiectomy on left ventricular mechanics evaluated by using speckle tracking echocardiography in patients with constrictive pericarditis. Ultrasound in Med & Biol. 2016;42:421-429
One year follow up analysis by speckle tracking after pericardiectomy in patients with constrictive pericarditis (n = 24). After surgery, all strain parameters showed a partial recovery towards normal. Further improvements occurred over time with normalization of global LV longitudinal and radial strains 12 mo after pericardiectomy.