P750Left ventricular diastolic parameters in MRI to differentiate constrictive pericarditis and restrictive cardiomyopathy


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Abstract

Background: Constrictive pericarditis (CP) and restrictive cardiomyopathies (RCM) are both characterized by a major alteration of ventricular compliance (adiastole). The differential diagnosis of these two different pathologies remains challenging. We studied the interest of MRI-derived left ventricular (LV) parameters, and particularly LV relaxation, that is presumed to be more altered in RCM.Methods: Cardiac MRI were retrospectively analyzed in 18 patients with a diagnosis of adiastole proved by the presence of a dip-plateau in right heart catheterization (RHC). 10 patients had a RCM and 8 had a CP. LV diastolic filling curves were determined from the Simpson method in cineSSFP sequences through serial and junctive LV short axis views. The calculated diastolic parameters were peak filling rate (PFR ml/s), time to PFR (TPFR) and diastolic volume recovery time (DVR, ms). DVR is the time in diastole to reach 80% of LV stroke volume. We analyzed the correlation of these parameters with pulmonary capillary wedge pressure (PCWP) during RHC and the etiology of adiastole.Results: DVR and PFR were correlated to PCWP (respectively R = -0.482, p=0.001; R=0.603, p=0.03). PFR and TPFR were not different in the two groups, whereas DVR was significantly higher in patients with RCM vs patients with CP (224 ± 98 ms vs 124 ± 74, p = 0.04). Using the median value of DVR observed in the 18 patients of the study (185 ms) as a cut-off value could predict the diagnosis of RCM with a predictive positive value of 87.5 % (figure 1).Conclusion: Measuring left ventricular DVR in MRI seems to be an interesting hemodynamic tool for the differential diagnosis of RCM or CP in patients presenting with adiastole. DVR increase is related to a strongly altered LV relaxation in RCM, which is usually preserved in isolated CP.

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