Mitral annular velocities by tissue Doppler are important
to acquire and analyze. In patients with restrictive cardiomyopathy,
myocardial relaxation is impaired, leading to
reductions in s´ and e´ velocities and an increase in the TE-e´
time interval.152–154 However, in patients with constriction,
annular vertical excursion is usually preserved (Figure 12). A
septal e´ velocity 7 cm/s is highly accurate in differentiating
patients with constrictive pericarditis from those with
restrictive cardiomyopathy. The limitations of e´ are in
patients with significant annular calcification and in those
with coexisting myocardial disease, when it is decreased
despite the presence of pericardial constriction. More
recent reports have shown that in some patients, e´ also
varies with respiration, but in an opposite direction to that
of mitral inflow.155 In addition, systolic strain is usually
reduced in patients with myocardial disease but tends to
be preserved in constriction (Table 3), where there are
signs of ventricular interdependence.