Doppler Echocardiographic Investigations

  • H. Acquatella


Restrictive cardiomyopathy is characterised by abnormal filling of the ventricles, consisting of a disproportionate rise in ventricular pressure in early diastole for a given increase in volume. Pathological changes in endomyocardial disease (with or without hypereosinophilia) affect ventricular compliance by unknown mechanisms leading to a restrictive pattern of filling. This haemodynamic profile is usually documented by cardiac catheterisation but may be recognised non-invasively by pulsed Doppler echocardiography of mitral and tricuspid inflow velocities. This profile consists of a short isovolumic relaxation time, increased peak early inflow velocity, increased early deceleration time, decreased late atrial inflow peak velocity, and an increased ratio of early/late peak flow velocities. Vena cava and pulmonary venous blood flow velocities disclose predominant filling during early diastole and severe blunting of normal ante-grade systolic flow. This restrictive profile is also presented by other endocardial or myocardial conditions. In pericardial constriction similar findings exist, but contrary to restriction these are greatly influenced by respiration. Endomyocardial biopsy is the diagnostic technique of choice during the early stages of endomyocardial disease. Two-dimensional echocardiography has increased the detection of endomyocardial fibrosis by showing a peculiar distribution of abnormal endocardium, obliteration of the ventricular apex, and the combination of near-normal-sized ventricles with dilated atria.


Tricuspid Regurgitation Constrictive Pericarditis Cardiac Amyloidosis Restrictive Cardiomyopathy Isovolumic Relaxation Time 
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  • H. Acquatella

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