Annulus paradoxus and annulus reversus on tissue Doppler in constrictive pericarditis

Annulus paradoxus and annulus reversus on tissue Doppler in constrictive pericarditis Annulus paradoxus The term “annulus paradoxus” was proposed by Ha JW et al to indicate the inverse correlation of E/E’ to pulmonary capillary wedge pressure (PCWP) on tissue Doppler evaluation in constrictive pericarditis. Usually a positive correlation is found in patients with primary myocardial disease between E/E’ and PCWP [1]. In their study of 10 patients, E’ was not elevated despite high left ventricular filling pressures. Hence E/E’ was low, with a mean 9 and it was <15 in 9 of their 10 patients. Another study of 130 surgically confirmed patients with constrictive pericarditis from Mayo clinic reported similar findings [2]. They noted significantly lower E/E’ ratios at medial mitral annulus in patients with constrictive pericarditis compared with patients without constrictive pericarditis (mean 5.8 vs 16.1). The authors acknowledged the preserved or accentuated E’ velocity in constrictive pericarditis leading to the lower than expected E/E’ in the setting of increased left ventricular filling pressure as annulus paradoxus. But Alraies MC et al challenged the concept of annulus paradoxus in constrictive pericarditis while reporting their study of 49 surgically confirmed constrictive pericarditis [3]. Their patients underwent right heart study with measurement of PCWP after an echocardiographic evaluation. They could not find an...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Echocardiography Source Type: blogs