American Journal of Cardiology

Volume 102, Issue 3 , Pages 357-362, 1 August 2008

Comparison of Usefulness of Tissue Doppler Imaging

Versus Brain Natriuretic Peptide for Differentiation of
Constrictive Pericardial Disease from Restrictive
Cardiomyopathy
 Partho P. Sengupta, MD
, 
 Vijay K. Krishnamoorthy, MD
, 
 Walter P. Abhayaratna, MBBS
, 
 Josef Korinek, MD
, 
 Marek Belohlavek, MD, PhD
, 
 Thoralf M. Sundt III, MD
, 
 Krishnaswamy Chandrasekaran, MD
, 
 James B. Seward, MD
, 
 A. Jamil Tajik, MD
, 
 Bijoy K. Khandheria, MD
Received 17 January 2008; received in revised form 17 March 2008; accepted 17 March 2008. published online 27
May 2008.
 Abstract
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 References
Brain (B-type) natriuretic peptide (BNP) and tissue Doppler imaging may distinguish restrictive cardiomyopathy
(RCMP) from idiopathic constrictive pericardial disease (CP). However, their comparative efficacy is unknown
for patients with CP from secondary causes (e.g., surgery or radiotherapy). We compared the efficacy of tissue
Doppler imaging and BNP for differentiation of RCMP (n = 15) and CP (n = 16). BNP was higher in patients
with RCMP than CP (p = 0.008), but the groups overlapped, particularly for BNP <400 pg/ml. BNP was lower
with idiopathic CP than secondary CP (139 ± 50 vs 293 ± 69 pg/ml; p <0.001) or RCMP (139 ± 50 vs 595 ± 499
pg/ml; p <0.001), but not significantly different between those with secondary CP and RCMP (293 ± 69 vs 595
± 499 pg/ml; p = 0.1). Patients with CP and RCMP had less overlap in early diastolic and isovolumic
contraction tissue Doppler imaging velocities compared with BNP, with clear separation of groups evident with
mean early diastolic annular velocities (averaged from 4 walls). Early diastolic tissue Doppler imaging velocity
was superior to BNP for differentiation of CP and RCMP (area under the curve 0.97 vs 0.76, respectively; p =
0.01). In conclusion, mean early diastolic mitral annular velocity correctly distinguished CP from RCMP even
when there was a large overlap of BNP between the 2 groups.