Background: Normal or exaggerated early diastolic mitral annular vleocity (E’) provides an excellent specificity for differentiating constrictive pericarditis (CP) from restrictive cardiomyopathy (RCM). However, its sensitivity has been shown to be low, especially in patients with CP who had underlying myocardial relaxational abnormality. We hypothesized that systolic mitral annular velocity (S’) or time difference in onset of mitral inflow and early diastolic mitral annulus velocity {T(E’-E)}has value for differentiation between CP and RCM. Methods: This study consisted of 44 subjects (28 men, 16 women; mean age 47 years, range 10 to 76); 17 patients with CP, 12 with RCM, and 15 controls. Standard mitral inflow Doppler and tissue Doppler echocardiography were performed. Results: E’ (9.5±1.7 cm/s vs. 4.7±1.6 cm/s, p <0.001) and S’ (7.7±1.3 cm/s vs.4.6±1.9 cm/s, p<0.001) was significantly higher, whereas T(E’-E) (21.0±32.0 ms vs. 53.1±30.4 ms, p=0.02) was significantly lower in patients with CP than that of RCM. ROC analysis showed that the diagnostic accuracy of E’ for differentiation of CP from RCM was higher than S’ or T (E’-E) (area under curve 0.99 vs. 0.87 vs. 0.74, respectively). E’ of 8cm/s has excellent specificity (100%) for differentiation of CP from RCM but sensitivity (70%) was relatively low. However, when combining E’ with S’ and T(E’-E), the sensitivity and diagnostic accuracy were increased when compared with E’ only {70% and 85% with E’, 88% and 94% with E’+S’ and 94% and 97% with E’+S’+T(E’-E)}. Conclusion: S’ and T(E’-E) can be helpful for differentiating between CP and RCM by providing incremental diagnostic information to E’
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