Strain Reversus Sign: Diagnostic Role and Correlation With Cardiac Magnetic Resonance Findings in Constrictive Pericarditis

Background: A typical echocardiographic longitudinal strain (LS) pattern of the left ventricle called strain reversus (SR) has been described in patients with constrictive pericarditis (CP). The aim of this study was to evaluate the prevalence of SR among pericardial diseases, its diagnostic role in CP, and its correlation with pericardial involvement assessed using cardiac magnetic resonance (CMR). Methods: Eighty-five patients (mean age, 57 ± 17 years; 32.8% women) with pericardial diseases who underwent clinically indicated echocardiography and CMR were retrospectively enrolled. Results: According to right heart catheterization findings, CP and nonconstrictive pericarditis were found in 24 and 61 patients, respectively. The prevalence of SR was higher in patients with CP compared with those with nonconstrictive pericarditis (91% vs 25%, P < .001) and was correlated with CP diagnosis (odds ratio [OR], 3.43; 95% CI, 1.39-5.49; P = .001). The addition of SR to the traditional Mayo Clinic criteria significantly improved the diagnostic accuracy of echocardiographic assessment of pericarditis, increasing the C statistic from 0.82 to 0.92 (P = .004), with a net reclassification improvement index of 0.198. SR was associated with pericardial thickening (OR, 2.30; 95% CI, 1.21-3.41; P = .001) and pericardial late gadolinium enhancement (OR, 1.55; 95% CI, 1.07-2.04; P = .036), but it was not linked to pericardial edema. Conclusions: SR is an echocardiographic sign associated with CP and pericardial involvement detected on CMR that provides additional diagnostic value to the traditional Mayo Clinic criteria.