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Respiratory Variation in Constriction — EECC MCQ

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ModeratePericardial DiseaseRespiratory Variation in ConstrictionEECC

A 55-year-old man with suspected constrictive pericarditis has echocardiographic features of ventricular interdependence (septal bounce, respiratory variation in mitral/tricuspid inflow velocities). What percentage of respiratory variation in mitral E velocity is considered diagnostic of constriction?

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Correct answer: C — Respiratory variation in mitral E velocity ≥25% — with inspiration, mitral E velocity decreases (reduced LV filling as the septum shifts leftward), while tricuspid E velocity increases reciprocally

In constrictive pericarditis, the rigid pericardium prevents transmission of intrathoracic pressure changes to the cardiac chambers, causing enhanced ventricular interdependence. During inspiration: (1) mitral E velocity decreases ≥25% (reduced LV filling as septum shifts leftward — the non-compliant pericardium means one ventricle can only fill at the expense of the other); (2) tricuspid E velocity increases (enhanced RV filling from negative intrathoracic pressure). During expiration: the reverse occurs. This respirophasic variation ≥25% on mitral E velocity (and reciprocal changes in tricuspid flow) is a key echocardiographic diagnostic criterion. In restrictive cardiomyopathy, ventricular interdependence is absent (the pericardium is normal and allows independent filling). The 2025 ESC Pericarditis Guidelines use these echocardiographic findings alongside CMR and haemodynamic data for constriction diagnosis.

Reference: ESC (2025): Myocarditis/Pericarditis Guidelines; ASE/EACVI Guidelines