What is the significance of diastolic septal bounce seen on Parasternal Long Axis (PLAX) Transthoracic Echocardiogram (TTE)?

From the Guidelines

Diastolic septal bounce seen on parasternal long axis (PLAX) transthoracic echocardiography (TTE) is a hallmark sign of constrictive pericarditis, characterized by an abrupt posterior movement of the interventricular septum during early diastole followed by an anterior rebound. This finding is associated with a thickened, fibrotic pericardium that restricts normal cardiac filling, leading to enhanced ventricular interdependence and dissociation between intracardiac and intrathoracic pressures. The provided evidence does not directly discuss diastolic septal bounce, but based on general medical knowledge, it is known that constrictive pericarditis is a condition where the pericardium becomes thickened and fibrotic, restricting the heart's ability to fill with blood normally. Some key points to consider when evaluating a patient with diastolic septal bounce include:

• Constrictive pericarditis is a key diagnosis to consider, and additional echocardiographic findings such as pericardial thickening, respiratory variation in mitral and tricuspid inflow velocities, and hepatic vein flow reversal should be assessed to confirm the diagnosis 1.
• Other conditions that can occasionally cause a septal bounce include severe right ventricular volume overload, right ventricular infarction, and after cardiac surgery.
• The use of advanced echocardiographic techniques, such as tissue Doppler imaging and speckle tracking, can provide additional insights into cardiac function and help guide diagnosis and management 1. It is essential to prioritize the diagnosis and treatment of constrictive pericarditis, as it can significantly impact morbidity, mortality, and quality of life. In clinical practice, a definitive diagnosis of constrictive pericarditis is crucial, and the use of TTE with additional echocardiographic findings is recommended to confirm the diagnosis. Based on the highest quality and most recent evidence, the diagnosis of constrictive pericarditis should be prioritized when a diastolic septal bounce is seen on PLAX TTE.

From the Research

Diastolic Septal Bounce on PLAX TTE

• Diastolic septal bounce is a sign that can be seen on parasternal long-axis (PLAX) view of a transthoracic echocardiogram (TTE) 2.
• It is characterized by a rapid inward movement of the interventricular septum during early diastole, followed by a rapid outward movement 3.
• This sign is often associated with constrictive pericarditis, a condition where the pericardium becomes thickened and fibrotic, restricting the filling of the heart 4, 5, 2.

Echocardiographic Features

• The diastolic septal bounce can be seen as a rapid septal motion during early diastole, which can be measured using tissue Doppler imaging or speckle tracking echocardiography 3, 6.
• Other echocardiographic features that can be seen in constrictive pericarditis include:
  • Respiration-related ventricular septal shift 4
  • Variation in mitral inflow E velocity 4
  • Medial mitral annular e' velocity 4
  • Hepatic vein expiratory diastolic reversal ratio 4
  • Pericardial thickening 2, 6

Diagnostic Value

• The diastolic septal bounce has a sensitivity of 62% and a specificity of 93% for diagnosing constrictive pericarditis 2.
• The combination of diastolic septal bounce with other echocardiographic features, such as ventricular septal shift and hepatic vein expiratory diastolic reversal ratio, can increase the diagnostic accuracy for constrictive pericarditis 4.
• The diastolic septal bounce can also be used to differentiate constrictive pericarditis from restrictive cardiomyopathy and other conditions that affect diastolic function 5, 6.