Constrictive pericarditis in the twenty-first century: An old disease revisited

Table 1 Sensitivity, specificity, positive predictive value and negative predictive value of echocardiographic parameters of Mayo Clinic Criteria for the diagnosis of constrictive pericarditis

Echocardiographic parameter	Sensitivity	Specificity	PPV	NPV
Respirophasic ventricular septal motion	94%	73%	93%	77%
MV e’ medial > 8 cm/second	81%	91%	97%	58%
Annulus reversus	71%	79%	93%	45%
Diastolic hepatic vein expiratory reversal/forward flow velocity ≥ 0.8	73%	66%	86%	42%
Respirophasic ventricular septal motion + MV e’ medial > 8 cm/second	80%	96%	99%	58%
Respirophasic ventricular septal motion + MV e’ medial > 8 cm/second + diastolic hepatic vein expiratory reversal/forward flow velocity ≥ 0.8	67%	99%	100%	50%

PPV: Positive predictive value; NPV: Negative predictive value; MV: Mitral valve.

Table 2 Comparative diagnostic performance of multimodality imaging in constrictive pericarditis

Finding	Echocardiography	CT scan	CMR
Pericardial thickening	Useful, TEE better, less commonly used	Very useful, best for demonstrating calcification	Very useful
Pericardial calcification	Useful	Very useful	Less useful
Inflammation	Less useful, limited ability	Less useful, may be possible with late iodine enhancement	Less useful, best modality
Tissue characterization	Less useful, limited ability	Less useful, limited ability	Very useful, best modality
Respirophasic ventricular septal shift	Useful, commonly used	Less useful	Very useful
IVC dilatation	Very useful, commonly used	Very useful	Very useful
Physiology, MV medial e’, hepatic vein flow reversal	Very useful, commonly used	Less useful, limited ability	Very useful, less commonly used
Current indication	First-line imaging modality	Second-line, if echo is inconclusive	Second-line, if echo is inconclusive

CMR: Cardiac magnetic resonance; CT: Computed tomography; IVC: Inferior vena cava; MV: Mitral valve; TEE: Transesophageal echocardiography.