Case

The following case shows the typical findings on deformation imaging known with this disorder.

We present a 30 year old male who was presented to the emergency department with clinical signs of a cardiac tamponade, which was confirmed by ultrasound. After pericardialcynthesis, clinical signs improved. All additional testing for the cause of this effusion were negative. After a few days he develops clinical and electrocardiographic signs of a pericarditis with moderate troponin release. This was treated with colchicine and NSAIDs for a few months due to persistent complaints. After concluding this therapy the following ultrasound images were recorded

Conventional ultrasound

Global LV systolic function is moderately reduced (calculated value: LVEF 45%). The pericardium is clearly thickened and shows some adhesion to the myocardial wall. No pericardial effusion is seen. Diastolic function is still normal in this individual. When considering this a “constrictive pericarditis (CP)”, it should be characterized by impaired diastolic filling caused by the external constraints of a fibrotic or inflamed pericardium (tethering).

Deformation imaging

This pericardial to myocardial tethering along the left ventricular (LV) and right ventricular (RV) free wall in CP, which is seen in this patient, results in isolated reduction in the magnitude of longitudinal deformation of the LV and RV free walls with preserved deformation of the interventricular septal wall. This was also clearly seen in this example:

Longitudinal deformation is preserved in the septal walls and is clearly reduced in the posterlateral walls (where also the thickening and tethering of the pericardium was seen), indicated by the yellow circles. Global longitudinal strain is moderately reduced to a value of -15%.

Three layer longitudinal strain also shows the endocardial to epicardial strain gradient, where longitudinal strain in the epicardium is severely affected by the tethering. This is not seen in the septal wall. This is demonstrated by the single wall recordings and the bulls-eye plots (see arrow heads).

Additional imaging (CMR)

CMR confirmed the thickened pericardium and delayed enhancement was seen not only in the pericardium (see stars in the figures below), but also in the epicardial myocardium in the posterolateral region (see arrowheads), corresponding to the regions with abnormal longitudinal strain.