Hot septum sign: diagnostic role and correlatIon with cardiac magnetic resonance findings in constrictive pericarditis. Stricter study.

A typical echocardiographic longitudinal strain (LS) pattern of the left ventricle (LV), called hot septum sign (HSS), has been described in patients with constrictive pericarditis (CP)1,2.

The aim of this study was to evaluate the prevalence of HSS among pericardial diseases, its diagnostic role in CP and its correlation with pericardial involvement assessed by cardiac magnetic resonance (CMR).

Eighty-five patients (mean age: 57±17 female: 32.8%) with pericardial diseases who underwent clinically indicated echocardiogram and CMR were retrospectively enrolled. According to right heart catheterization findings, CP and non-constrictive pericarditis (NCP) were found in 24 and 61 patients, respectively. The prevalence of HSS was higher in CP cases as compared to NCP (91% vs 25%, p < 0.001) and correlated with CP diagnosis [OR: 3.43, CI: 1.39 - 5.49), p 0.001)]. The addition of HSS to traditional Mayo Clinic Criteria significantly improved the diagnostic accuracy of echocardiographic assessment of pericarditis with a C-statistic from 0.82 to 0.92 (p:0.004) and a net reclassification improvement index of 0.198 (figure 1). HSS was associated with pericardial thickening (OR:2.30, CI: 1.21 - 3.41; p 0.001) and pericardial late gadolinium enhancement (OR: 1.55, CI: 1.07 – 2.04; p 0.036), but it was not linked to pericardial oedema (figure 2).

HSS is an echocardiographic sign associated to CP and pericardial involvement detected by CMR that provide additional diagnostic value to the traditional Mayo Clinic Criteria.

Comparison of ROC curves.