Mayo Clinic echocardiographic criteria for constrictive pericarditis

Mayo Clinic echocardiographic criteria were formulated using data from 130 surgically confirmed cases of constrictive pericarditis. For comparison, there were 36 cases of restrictive myocardial disease or severe tricuspid regurgitation in which constrictive pericarditis was ruled out. Five echocardiographic patterns were selected based on previous studies. They were: 1. Respiration related shift of the ventricular septum 2. Variation in mitral inflow E velocity 3. Medial mitral annular e’ velocity 4. Ratio of medial mitral annular e’ to lateral e’ 5. Hepatic vein expiratory diastolic reversal ratio. All these variables differed significantly between the two groups.

Of these, three variables were independently associated with constrictive pericarditis: 1. Ventricular septal shift 2. Medial mitral e’ and 3. Hepatic vein expiratory diastolic reversal ratio. Presence of ventricular septal shift along with either medial e’ ≥9 cm/s or hepatic vein expiratory diastolic reversal ratio ≥0.79 gave a sensitivity of 87% and specificity of 91%. If all the three features were there, specificity became 97%, with a loss of sensitivity to 64%, as anticipated.

Reference

1. Welch TD, Ling LH, Espinosa RE, Anavekar NS, Wiste HJ, Lahr BD, Schaff HV, Oh JK. Echocardiographic diagnosis of constrictive pericarditis: Mayo Clinic criteria. Circ Cardiovasc Imaging. 2014 May;7(3):526-34. doi: 10.1161/CIRCIMAGING.113.001613. Epub 2014 Mar 14. PMID: 24633783.