Abstract 15027: Restrictive Cardiomyopathy With Constrictive Physiology as a Late Complication of Radiation Therapy

Distinguishing constrictive pericarditis from restrictive cardiomyopathy hemodynamics is a challenging process. CP a curable cause of heart failure, whereas RCM treatment options are limited. Mixed physiology is feared complication in patients with radiation exposure. Clinical Case46 yo Caucasian female presents with progressively worsening dyspnea for one week. She had Hodgkin’s Lymphoma s/p chest radiation ’84, Aortic valve stenosis s/p Mechanical AVR 2008, A Fib/A Flutter s/p RFA and Medtronic PPM in 2009. Pulse is 93/min and BP is 119/81 mm Hg. Chest exam reveals bilaterally equal, normal vesicular breath sounds. Cardiovascular exam reveals holosystolic murmur grade II/VI at aortic region. Echocardiography shows dilated left and right atria, with moderate MR, LVEF 48%, PA systolic pressure 26 mmHg with thickened and calcified pericardium. Doppler shows increased early diastolic filling (E) to atrial filling (A) (E/A) ratio (1.29), mitral flow (E-0.11), and pulmonary flow (0.90 m/s). Left Atrium volume index noted as 60.8 mL consistent with increased Left atrial pressure. RHC shows PA diastolic 12-13 mmHg, RAP 14 mmHg, PCWP 18 mmHg. In light of mixed RCM and CP, patient is referred for a heart transplant.DiscussionRadiation-induced heart disease has latency of 10-15 years and can manifest as coronary artery disease, valvular cardiac dysfunction, cardiomyopathy, and chronic constrictive pericarditis. Abnormal elastic properties of myocardium reduce compliance in RCM, external pericardial constraints reduce chamber compliance in CP. In both RCM and CP, left ventricular filling time is short. Calcified pericardium, with elevated LAP is consistent with mixed physiology. Equalization of diastolic right ventricular and left ventricular pressure, as seen in our patient is suggestive of RCM. Despite clinical, noninvasive, and hemodynamic assessment, differentiation is difficult in patients with mixed restrictive/constrictive physiology.