Advances in differentiating restrictive cardiomyopathy from constrictive pericarditis has been gained by examining echocardiographic measures of diastolic function. Using Doppler echocardiography, Appleton et al1 demonstrated an increase in right ventricular (RV) size and a concomitant decrease in left ventricular (LV) size during inspiration in patients with constriction. Using these same techniques, Hatle et al2 showed opposite changes in inflow velocity across the mitral and tricuspid valves in patients with constrictive pericarditis but not restrictive cardiomyopathy. Despite these improvements in distinguishing restrictive cardiomyopathy from constrictive pericarditis in patients at rest, there have been few studies examining the effect of dynamic maneuvers on diastole as a means of distinguishing these 2 conditions. We addressed the hemodynamic differentiation of restrictive cardiomyopathy and constrictive pericarditis by evaluating the separation of LV and RV end-diastolic pressures after physiologic maneuvers. The traditional method for developing maximal separation of RV and LV end-diastolic pressures is rapid intravenous infusion of saline solution.3 This method allows separation of end-diastolic pressures in patients with restrictive cardiomyopathy but not constrictive pericarditis.3,4 Most patients with these disease states have elevated diastolic pressures, and a fluid challenge is potentially unsafe. Accordingly, we tested the hypothesis that dynamic hand exercise could provide a safe alternate means of maximizing the separation of LV and RV end-diastolic pressures in patients with restrictive cardiomyopathy but not constrictive pericarditis.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine