The differential diagnosis of restrictive myocardiopathy and chronic constrictive pericarditis without calcification: Value of coronary arteriography

The coronary arteriograms of 106 patients were analyzed to determine the angiographic relation of the coronary vessels to the ventricular epicardium. Six of these 106 patients had hemodynamic findings suggesting restriction. One of these 6 patients had documented calcific constrictive pericarditis. It was determined that (1) the ventricular epicardium can easily be delineated by the coronary arteries in patients without pericardial thickening or effusion; (2) extension of the heart shadow beyond the defined epicardium under these circumstances represents pericardial thickening; and (3) patients with primary myocardial restriction can be distinguished from those with chronic constrictive pericarditis without calcification by utilizing coronary arteriography to define the ventricular epicardium.