Vaitkus and Kussmaul developed an algorithm for distinguishing constrictive pericarditis and restrictive cardiomyopathy. The authors are from the University of Pennsylvania in Philadelphia.
Parameters:
(1) thickness of the pericardium on imaging studies
(2) number of hemodynamic criteria present
(3) availability of endomyocardial biopsy for detection of restrictive cardiomyopathy
Hemodynamic criteria for constrictive pericarditis:
(1) (left ventricular end diastolic pressure) - (right ventricular end diastolic pressure) <= 5 mm Hg
(2) right ventricular systolic pressure <= 50 mm Hg
(3) radio of (right ventricular end diastolic pressure) / (right ventricular systolic pressure >= 0.33
|
Thickness of Pericardium
|
Number of Hemo-dynamic Criteria
|
Probability of Constriction
|
|
thickened
|
1 to 3
|
high
|
|
thickened
|
0
|
indeterminate
|
|
not thickened
|
0 or 1
|
low
|
|
not thickened
|
2 or 3
|
indeterminate
|
Endomyocardial biopsy is performed if available for:
(1) indeterminate cases
(2) to confirm low probability of constrictive pericarditis
Surgery is performed:
(1) when there is a high probability of constrictive pericarditis
(2) when there is an indeterminate probability of constrictive pericarditis and endomyocardial biopsy is not available
(3) when there is an indeterminate probability of constrictive pericarditis and endomyocardial biopsy is negative for infiltrative cardiomyopathy
Medical therapy is given:
(1) when there is a low probability of constrictive pericarditis
(2) when there is an indeterminate probability of constrictive pericarditis and endomyocardial biopsy is positive for infiltrative cardiomyopathy
