Detection of constrictive pericarditis by echocardiography: the value of monitoring changes in chamber size

Background and Purpose

Constrictive pericarditis can be mistaken for heart failure with preserved ejection fraction (HFpEF). This study aimed to assess whether serial echocardiographic measurements can detect changes in cardiac chamber dimensions and atrial volumes in patients with constrictive pericarditis, in contrast to HFpEF, and whether these changes can help distinguish between the two conditions.

Methods

Seven patients with constrictive pericarditis were identified at our clinic between 2010 and 2024 and were matched in a 1:2 ratio with control patients with HFpEF by age and sex. Baseline and follow-up echocardiographic examinations were analysed for chamber dimensions, atrial volumes, ejection fraction, stroke volume and cardiac output in both groups. Fitted mixed-effect models were used to compare change in measures from baseline to follow-up in patients with constrictive pericarditis and HFpEF.

Results

In total, 21 patients were included, 15 (71%) were male, with a median age of 70 years. The mean time interval between the baseline and follow up examinations was 18 months in the constrictive pericarditis and 28 months in the HFpEF group. Changes in left ventricular end-diastolic diameter (−13.9 mm, 95% CI −22.4 to −5.47) and left ventricular end-systolic diameter (−9.71 mm, 95% CI −18.2 to −1.26) differed significantly between groups. Changes in ejection fraction (−8.86 %, 95% CI −17.3 to −0.402), right atrial volume index (−10.9 ml/m², 95% CI −20.4 to −1.36), stroke volume (−18.7 ml, 95% CI −27.7 to −9.68) and indexed stroke volume (−9.84 ml/m², 95% CI −18.7 to −0.926) also differed significantly between groups. In contrast, no significant differences in changes were found for cardiac output, left atrial volume index, right ventricular end-diastolic or end-systolic diameter.

Conclusion

Despite the limited sample size of this study, significant differences in changes of left ventricular diameters, ejection fraction, right atrial volume index, and stroke volume were observed between constrictive pericarditis and HFpEF, whereas no significant difference were observed in cardiac output, left atrial volume index and right ventricular diameters.

Our results suggest that repeated echocardiographic measurements may provide useful diagnostic information for distinguishing constrictive pericarditis from HFpEF. Confirmation of these findings is needed in a larger group of patients.