151
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A girl with right heart failure related to effusive-constrictive pericarditis. Pediatr Cardiol 2011; 32:681-4. [PMID: 21359949 DOI: 10.1007/s00246-011-9927-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 02/06/2011] [Indexed: 01/22/2023]
Abstract
Effusive-constrictive pericarditis is characterized by constriction of visceral pericardium with a coexisting tense pericardial effusion. We report a 10-year-old girl with right heart failure due to effusive-constrictive pericarditis. She did not present typical features, such as cardiac tamponade or thickening of pericardium (visceral and parietal), but constrictive physiology was observed by echocardiography and cardiac computed tomography. These noninvasive imaging modalities provided clinical clues to make precise diagnosis. The patient underwent surgical drainage of pericardial fluid and visceral pericardiectomy, which resulted in improved hemodynamics and symptoms.
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152
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Yu HT, Ha JW, Lee S, Shim CY, Moon J, Cho IJ, Kang MK, Yang WI, Choi D, Chung N. Transient right ventricular dysfunction after pericardiectomy in patients with constrictive pericarditis. Korean Circ J 2011; 41:283-6. [PMID: 21731572 PMCID: PMC3116109 DOI: 10.4070/kcj.2011.41.5.283] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 09/03/2010] [Accepted: 09/07/2010] [Indexed: 11/12/2022] Open
Abstract
Pericardiectomy is the standard treatment in patients with chronic constrictive pericarditis who have persistent symptoms. However, myocardial atrophy with prolonged pericardial constriction and abrupt increase in venous return can lead to heart failure with volume overload after pericardial decompression, especially in the right ventricle (RV). We experienced a 44 year old male patient who developed transient RV failure after pericardiectomy for constrictive pericarditis. Echocardiography revealed a markedly dilated RV with decreased peak systolic velocity of the tricuspid annulus, suggesting severe RV dysfunction. After treatment with inotropics and diuretics, a follow-up echocardiography revealed an improved systolic function with decreased RV chamber size. This case demonstrates the importance of volume overload and RV dysfunction in patients with constrictive pericarditis undergoing pericardiectomy.
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Affiliation(s)
- Hee Tae Yu
- Cardiology Division, Severence Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
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153
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Affiliation(s)
- T Tak
- Division of Cardiology, Franciscan Skemp Healthcare, Mayo Health System, La Crosse, WI, 54601, USA,
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154
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Affiliation(s)
- Michael C Reed
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109-5869, USA.
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155
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Cheng H, Zhao S, Jiang S, Lu M, Yan C, Ling J, Zhang Y, Liu Q, Ma N, Yin G, Jerecic R, He Z. The relative atrial volume ratio and late gadolinium enhancement provide additive information to differentiate constrictive pericarditis from restrictive cardiomyopathy. J Cardiovasc Magn Reson 2011; 13:15. [PMID: 21349202 PMCID: PMC3058035 DOI: 10.1186/1532-429x-13-15] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 02/25/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The differentiation of constrictive pericarditis (CP) from restrictive cardiomyopathy (RCM) is often difficult. This study sought to determine the clinical utility of cardiovascular magnetic resonance imaging (CMR) for differentiating both these disorders. METHODS Twenty-three patients with surgically documented CP, 22 patients with RCM and 25 normal subjects were included in the study. CMR yielded information about cardiac morphology, function and tissue characteristics. The left (LA) and right atrial (RA) volume was calculated using the area-length method. The relative atrial volume ratio (RAR) was defined as the LA volume divided by RA volume. Receiver operating characteristic curve analysis was used to test the ability of different variables in differentiating CP from RCM. RESULTS The maximal pericardial thickness in CP patients was significantly larger than in normal subjects and RCM patients. The RA volume index in RCM patients (90.5 ± 35.3 mL/m2) was significantly larger than in CP patients (71.4 ± 15.7 mL/m2, p = 0.006) and normal subjects (38.1 ± 9.0 mL/m2, p < 0.001). The LA volume index in RCM (96.0 ± 37.0 mL/m2) and CP patients (105.6 ± 25.1 mL/m2) was significantly larger than in normal subjects (39.5 ± 9.5 mL/m2, p < 0.001 for all). The RAR in CP patients (1.50 ± 0.29) was significantly larger than in RCM patients (1.12 ± 0.33, p < 0.001) and normal subjects (1.06 ± 0.20, p < 0.001). There were no differences between RCM patients and normal subjects in the RAR (p = 0.452). At a cut-off value of 1.32 for the RAR, the sensitivity was 82.6%, and the specificity was 86.4% in the detection of CP. Septal bounce was identified in 95.7% CP patients, in none of RCM patients and normal subjects. Late gadolinium enhancement (LGE) was present in 31.8% RCM patients and absence in all CP patients and normal subjects. CONCLUSIONS CMR with LGE and RAR can facilitate differentiation of CP from RCM.
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Affiliation(s)
- Huaibing Cheng
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Shihua Zhao
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Shiliang Jiang
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Minjie Lu
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Chaowu Yan
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Jian Ling
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Yan Zhang
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Qiong Liu
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Ning Ma
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Gang Yin
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Renate Jerecic
- MR Research and Development, Siemens Medical Solutions USA, Inc., Chicago, IL, USA
| | - Zuoxiang He
- Department of Nuclear medicine, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
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156
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van Leeuwen-Segarceanu EM, Bos WJW, Dorresteijn LDA, Rensing BJWM, der Heyden JASV, Vogels OJM, Biesma DH. Screening Hodgkin lymphoma survivors for radiotherapy induced cardiovascular disease. Cancer Treat Rev 2011; 37:391-403. [PMID: 21333452 DOI: 10.1016/j.ctrv.2010.12.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 12/05/2010] [Accepted: 12/07/2010] [Indexed: 12/22/2022]
Abstract
Long term prognosis of Hodgkin lymphoma (HL) survivors is affected by late toxicity of radiotherapy and chemotherapy. Cardiovascular complications of radiotherapy have been shown to have a great impact on the long term survival. The aim of this review is to summarize the available data on different screening modalities for cardiovascular disease and to suggest a screening program. Patients older than 45 years at HL diagnosis should be screened for coronary artery disease (CAD) starting 5 years after mediastinal radiotherapy; they are at increased risk of pre-existent atherosclerosis which can be accelerated by radiotherapy. Screening for CAD should start 10 years after radiotherapy in younger patients. The best screening modality for CAD is subject of discussion, based on the latest studies we suggest screening by Coronary artery calcium score measurements or CT-angiography. Valvular disorders should be looked for by echocardiography starting 10 years after radiotherapy. Electrocardiograms should be performed at each cardiovascular screening moment in order to detect arrhythmia's or conduction abnormalities. We suggest repeating these screening tests every 5 years or at onset of cardiovascular complaints; patients should be extensively instructed about signs and symptoms of cardiovascular disease. Furthermore traditional risk factors for cardiovascular disease should be carefully monitored and treated. We suggest determining a cardiovascular risk profile at diagnosis of HL in patients older than 45 years. In case of a high risk, treating HL without RT should be considered.
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157
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Mastouri R, Sawada SG, Mahenthiran J. Noninvasive imaging techniques of constrictive pericarditis. Expert Rev Cardiovasc Ther 2010; 8:1335-47. [PMID: 20828356 DOI: 10.1586/erc.10.77] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Constrictive pericarditis (CP) is the result of scarring and loss of elasticity of the pericardial sac, resulting in external impedance of cardiac filling. It can occur after virtually any pericardial disease process. Patients typically present with signs and symptoms of right heart failure and/or low cardiac output. An important pathophysiological hallmark of CP is exaggerated ventricular interdependence and impaired diastolic filling. Echocardiography is the initial imaging modality for diagnosis of CP. Unfortunately, no echocardiographic sign or combination of signs is pathognomonic for CP. CT scan and cardiac MRI are other imaging techniques that can provide incremental diagnostic information. CT scan can easily detect pericardial thickening and calcification, while cardiac MRI provides a comprehensive evaluation of the pericardium, myocardium and cardiac physiology. Occasionally, a multimodality approach needs to be considered for the conclusive diagnosis of CP.
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Affiliation(s)
- Ronald Mastouri
- Department of Medicine of Indiana University Medical Center and the Krannert Institute of Cardiology, Indianapolis, IN, USA
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158
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Akyuz S, Yaylak B, Ergelen M, Uyarel H. Transient constrictive pericarditis: an elusive diagnosis. Future Cardiol 2010; 6:785-90. [DOI: 10.2217/fca.10.84] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Constrictive pericarditis (CP) is caused by reduction in the elasticity of the pericardium resulting in impaired diastolic filling of the heart. All types of CP were thought to be irreversible in the past. This led to a belief that all patients with CP should undergo pericardiectomy. However, at present, it is well established that selected patients can be treated without pericardiectomy, leading to the concept of transient CP. Clinical improvement can be spontaneous or accomplished with empirical medical therapy administered for several months. As for chronic form, transient CP may not be recognized due to the difficulty in establishing the diagnosis because of the absence of any single method that is 100% sensitive and specific. It is worth considering the possibility of transient type when constrictive physiology is detected by noninvasive methods because correct diagnosis may prevent the inflamed pericardium from becoming the chronic fibrotic type that can be associated with more serious consequences including pericardiectomy.
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Affiliation(s)
- Sukru Akyuz
- Nusaybin State Hospital, Department of Cardiology, Mardin, Turkey; Isik Sitesi, E Blok, D7 Nusaybin,Mardin, Turkey
| | - Barış Yaylak
- Siyami Ersek Cardiovascular & Thoracic Surgery Center, Department of Cardiology, Istanbul, Turkey
| | - Mehmet Ergelen
- Siyami Ersek Cardiovascular & Thoracic Surgery Center, Department of Cardiology, Istanbul, Turkey
| | - Huseyin Uyarel
- Balıkesir University, School of Medicine, Department of Cardiology, Balıkesir, Turkey
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159
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Multimodality imaging of pericardial diseases. JACC Cardiovasc Imaging 2010; 3:650-60. [PMID: 20541720 DOI: 10.1016/j.jcmg.2010.04.009] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 04/26/2010] [Accepted: 04/29/2010] [Indexed: 11/20/2022]
Abstract
Pericardial disease is an important cause of morbidity and mortality in patients with cardiovascular disease. Inflammatory diseases of the pericardium constitute a spectrum ranging from acute pericarditis to chronic constrictive pericarditis. Other important entities that involve the pericardium include benign and malignant pericardial masses, pericardial cysts, and diverticula, as well as congenital absence of the pericardium. Recent advances in multimodality noninvasive cardiac imaging have solidified its role in the management of patients with suspected pericardial disease. The physiologic and structural information obtained from transthoracic echocardiography and the anatomic detail provided by cardiac computed tomography and magnetic resonance have led to growing interest in the complementary use of these techniques. Optimal management of the patient with suspected pericardial disease requires familiarity with the key imaging modalities and the ability to choose the appropriate imaging tests for each patient. This report reviews the imaging modalities most useful in the assessment of patients with pericardial disease, with an emphasis on the complementary value of multimodality cardiac imaging.
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160
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Dacher JN, Caudron J, Fares J, Germain P. [Chronic constrictive pericarditis: MR imaging features]. ACTA ACUST UNITED AC 2010; 91:623-9. [PMID: 20657368 DOI: 10.1016/s0221-0363(10)70078-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Chronic constrictive pericarditis is defined by an increase in the rigidity of the pericardium resulting in impairment of the ventricular filling conditions. Cardiac MR is both a morphological and functional study always complemented by multi-detector CT. Morphological analysis is based on axial, longitudinal long axis and short axis views on Turbo (fast) SE Dark Blood and CINE sequences. Functional analysis is based on real-time acquisitions in the short axis at the base of the ventricles by comparing spontaneous breathing and deep breathing. The excursion of the interventricular septum is a reliable sign of constriction. The study is supplemented by phase contrast acquisitions. In the setting of persistent inflammation or free pericardial fluid, delayed enhancement 3D and 2D sequences including Phase Sensitive Inversion Recovery (PSIR) are useful.
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Affiliation(s)
- J-N Dacher
- Service de Radiologie, CHU de Rouen et LITIS EA 4108, 1 rue de Germont, 76031 Rouen cedex, France.
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161
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Cardiac computed tomography and magnetic resonance imaging: the clinical use from a cardiologist's perspective. J Thorac Imaging 2010; 25:194-203. [PMID: 20711035 DOI: 10.1097/rti.0b013e3181eaadac] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The introduction and continued evolution of cardiac computed tomography and magnetic resonance imaging have added considerable noninvasive diagnostic insight into a wide range of frequently encountered clinical cardiology scenarios. With an increasing range of imaging modalities, and multiple methods of image acquisition in each, a detailed understanding of the clinical question at hand is often necessary to select the proper study and make optimal use of imaging data. We review common cardiac issues from a clinician's perspective, along with the unique role to be played by computed tomography and magnetic resonance imaging in each condition. This review will hopefully facilitate a strong dialogue between imagers and managing clinicians, creating a shared knowledge of both the capabilities of imaging and the management challenges that treating clinicians face.
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162
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Clare GC, Troughton RW. Management of constrictive pericarditis in the 21st century. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2010; 9:436-42. [PMID: 18221595 DOI: 10.1007/s11936-007-0038-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Definitive treatment for constrictive pericarditis is surgical pericardiectomy. Because constriction may be transient in a small proportion of patients, particularly those with exudative effusions, the initial treatment for constrictive pericarditis should be conservative, with loop diuretic therapy to manage volume expansion and edema and the use of colchicine, nonsteroidal anti-inflammatory agents, or, if necessary, glucocorticoid therapy for active inflammation. For subjects with persisting evidence of constriction, symptomatic management is advised for those with only minimal symptoms. Surgical pericardiectomy is advised for subjects with New York Heart Association class II or III symptoms and persisting evidence of constriction at echocardiography and cardiac catheterization and with associated pericardial abnormality on CT or MRI. Complete resection of the pericardium and, where possible, the diseased epicardium via a midline sternotomy is the favored approach, although a video-assisted thoracoscopic approach may be suitable in some subjects. Lateral thoracotomy should be used for suppurative pericarditis to avoid sternal infection. Because of higher mortality, increased complication rates, and suboptimal clinical outcomes, pericardiectomy should be avoided in older patients or those with radiation-induced disease, very advanced symptoms, or evidence of myocardial fibrosis.
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Affiliation(s)
- Geoffrey C Clare
- University Department of Medicine, Christchurch Hospital, PO Box 4345, Christchurch, New Zealand
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163
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Verhaert D, Gabriel RS, Johnston D, Lytle BW, Desai MY, Klein AL. The role of multimodality imaging in the management of pericardial disease. Circ Cardiovasc Imaging 2010; 3:333-43. [PMID: 20484113 DOI: 10.1161/circimaging.109.921791] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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164
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Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG, Ho VB, Jerosch-Herold M, Kramer CM, Manning WJ, Patel M, Pohost GM, Stillman AE, White RD, Woodard PK. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol 2010; 55:2614-62. [PMID: 20513610 PMCID: PMC3042771 DOI: 10.1016/j.jacc.2009.11.011] [Citation(s) in RCA: 445] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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165
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Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG, Ho VB, Jerosch-Herold M, Kramer CM, Manning WJ, Patel M, Pohost GM, Stillman AE, White RD, Woodard PK. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation 2010; 121:2462-508. [PMID: 20479157 PMCID: PMC3034132 DOI: 10.1161/cir.0b013e3181d44a8f] [Citation(s) in RCA: 226] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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166
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Khandaker MH, Espinosa RE, Nishimura RA, Sinak LJ, Hayes SN, Melduni RM, Oh JK. Pericardial disease: diagnosis and management. Mayo Clin Proc 2010; 85:572-93. [PMID: 20511488 PMCID: PMC2878263 DOI: 10.4065/mcp.2010.0046] [Citation(s) in RCA: 171] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pericardial diseases can present clinically as acute pericarditis, pericardial effusion, cardiac tamponade, and constrictive pericarditis. Patients can subsequently develop chronic or recurrent pericarditis. Structural abnormalities including congenitally absent pericardium and pericardial cysts are usually asymptomatic and are uncommon. Clinicians are often faced with several diagnostic and management questions relating to the various pericardial syndromes: What are the diagnostic criteria for the vast array of pericardial diseases? Which diagnostic tools should be used? Who requires hospitalization and who can be treated as an outpatient? Which medical management strategies have the best evidence base? When should corticosteroids be used? When should surgical pericardiectomy be considered? To identify relevant literature, we searched PubMed and MEDLINE using the keywords diagnosis, treatment, management, acute pericarditis, relapsing or recurrent pericarditis, pericardial effusion, cardiac tamponade, constrictive pericarditis, and restrictive cardiomyopathy. Studies were selected on the basis of clinical relevance and the impact on clinical practice. This review represents the currently available evidence and the experiences from the pericardial clinic at our institution to help guide the clinician in answering difficult diagnostic and management questions on pericardial diseases.
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Affiliation(s)
| | | | | | | | | | | | - Jae K. Oh
- Address correspondence to Jae K. Oh, MD, Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (). Individual reprints of this article and a bound reprint of the entire Symposium on Cardiovascular Diseases will be available for purchase from our Web site www.mayoclinicproceedings.com
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167
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O'Leary SM, Williams PL, Williams MP, Edwards AJ, Roobottom CA, Morgan-Hughes GJ, Manghat NE. Imaging the pericardium: appearances on ECG-gated 64-detector row cardiac computed tomography. Br J Radiol 2010; 83:194-205. [PMID: 20197434 DOI: 10.1259/bjr/55699491] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Multidetector row computed tomography (MDCT) with its high spatial and temporal resolution has now become an established and complementary method for cardiac imaging. It can now be used reliably to exclude significant coronary artery disease and delineate complex coronary artery anomalies, and has become a valuable problem-solving tool. Our experience with MDCT imaging suggests that it is clinically useful for imaging the pericardium. It is important to be aware of the normal anatomy of the pericardium and not mistake normal variations for pathology. The pericardial recesses are visible in up to 44% of non-electrocardiogram (ECG)-gated MDCT images. Abnormalities of the pericardium can now be identified with increasing certainty on 64-detector row CT; they may be the key to diagnosis and therefore must not be overlooked. This educational review of the pericardium will cover different imaging techniques, with a significant emphasis on MDCT. We have a large research and clinical experience of ECG-gated cardiac CT and will demonstrate examples of pericardial recesses, their variations and a wide variety of pericardial abnormalities and systemic conditions affecting the pericardium. We give a brief relevant background of the conditions and reinforce the key imaging features. We aim to provide a pictorial demonstration of the wide variety of abnormalities of the pericardium and the pitfalls in the diagnosis of pericardial disease.
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Affiliation(s)
- S M O'Leary
- Department of Clinical Radiology, Derriford Hospital, Plymouth PL6 8DH, UK.
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168
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Wachter R, Hasenfuss G. [A rare cause of right heart failure]. ACTA ACUST UNITED AC 2010; 105:310-3. [PMID: 20455056 DOI: 10.1007/s00063-010-1040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CASE REPORT The case of a 46-year-old male with progressive dyspnea on exertion and severe headache while having the head lowered is described. Clinically, the patient showed left-sided pleural effusion, jugular venous distension, and a congested liver. During cardiologic work-up, echocardiography, combined left/right heart catherization and magnetic resonance imaging established the diagnosis of constrictive pericarditis. Under conservative medical treatment, the patient again developed cardiac decompensation and, therefore, a pericardectomy was performed. Immediately after surgery, symptoms diminished and exercise tolerance increased. The patient is currently in cardiac rehabilitation. CONCLUSION Constrictive pericarditis is a rare differential diagnosis of right heart failure. Especially in patients with congested inferior vena cava, but normal systolic left ventricular function and normal function of the cardiac valves, constrictive pericarditis should be considered as a differential diagnosis.
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Affiliation(s)
- Rolf Wachter
- Abteilung Kardiologie und Pneumologie, Herzzentrum Göttingen, Göttingen, Germany
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169
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Croisille P. [Restrictive cardiomyopathy versus constrictive pericarditis in patients with diastolic dysfunction: MR imaging features]. JOURNAL DE RADIOLOGIE 2010; 91:630-638. [PMID: 20657369 DOI: 10.1016/s0221-0363(10)70079-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Restrictive cardiomyopathies are characterized by diastolic dysfunction while systolic function is usually preserved. MRI is helpful by its ability to characterize tissues, especially the demonstration of interstitial or nodular fibrosis based on the underlying etiology. In the presence of constrictive pericarditis from pericardial inflammation, fibrosis or calcifications, diastolic expansion is impaired resulting in poor diastolic ventricular filling, resulting in a characteristic type of diastolic impairment, adiastole. MRI can demonstrate the underlying anatomical lesion: pericardial thickening, though the presence of a pericardium or normal thickness does not entirely exclude the possibility of constriction. As such, the presence of additional imaging features such as abnormal right ventricular shape, vena cava dilatation, and paradoxical movement of the intraventricular septum, during operator-guided deep respiration.
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Affiliation(s)
- P Croisille
- Hôpital Cardiologique L. Pradel, Service de Radiologie, 28 avenue Doyen Lepine, Lyon 69677, France.
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170
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171
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Föll D, Geibel-Zehender A, Bode C. Pericarditis constrictiva: Ätiologie, Diagnostik und Therapie. Herz 2010; 35:80-5. [DOI: 10.1007/s00059-010-3322-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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172
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Kim TY, Choi JB, Lee MK, Kim KH, Kim MH. Pericardiectomy by a Left Limited Anterolateral Thoracotomy for Constrictive Pericarditis after Cardiac Surgery-2 case reports-. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.2.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tae Yun Kim
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School
| | - Jong Bum Choi
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School
| | - Mi Kyung Lee
- Department of Thoracic and Cardiovascular Surgery, Wonkwang University School of Medicine
| | - Kyung Hwa Kim
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School
| | - Min Ho Kim
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School
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173
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Karolak W, Cypel M, Chen F, Daniel L, Chaparro C, Keshavjee S. Constrictive pericarditis after lung transplantation: an under-recognized complication. J Heart Lung Transplant 2010; 29:578-81. [PMID: 20207169 DOI: 10.1016/j.healun.2009.11.606] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Revised: 11/02/2009] [Accepted: 11/05/2009] [Indexed: 11/30/2022] Open
Abstract
Primary graft dysfunction, acute rejection, and infection account for most of the early morbidity after lung transplantation, with bronchiolitis obliterans syndrome accounting for most late morbidity. Mediastinal and pericardial complications, in the form of constriction, are not common. We present 4 patients with constrictive pericarditis after lung transplantation and recommend that constrictive pericarditis be considered in the differential diagnosis in lung transplant recipients who present with signs and symptoms of systemic and pulmonary venous congestion.
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Affiliation(s)
- Wojtek Karolak
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
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174
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New observations from MR velocity-encoded flow measurements concerning diastolic function in constrictive pericarditis. Eur Radiol 2010; 20:1831-40. [DOI: 10.1007/s00330-010-1741-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 12/14/2009] [Accepted: 01/08/2010] [Indexed: 10/19/2022]
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175
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Bansal R, Perez L, Razzouk A, Wang N, Bailey L. Pericardial constriction after cardiac transplantation. J Heart Lung Transplant 2010; 29:371-7. [DOI: 10.1016/j.healun.2009.07.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 07/18/2009] [Accepted: 07/28/2009] [Indexed: 10/20/2022] Open
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176
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Bogaert J, Centonze M, Vanneste R, Francone M. Cardiac and pericardial abnormalities on chest computed tomography: what can we see? Radiol Med 2010; 115:175-90. [DOI: 10.1007/s11547-010-0514-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 07/13/2009] [Indexed: 11/30/2022]
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177
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Jiamsripong P, Mookadam F, Oh JK, Khandheria BK. Spectrum of pericardial disease: part II. Expert Rev Cardiovasc Ther 2009; 7:1159-69. [PMID: 19764867 DOI: 10.1586/erc.09.79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pericardial disease is a common disorder seen in varying clinical settings, and may be the first manifestation of an underlying systemic disease. In part I, we focused on the current knowledge and management of the more common pericardial diseases: acute pericarditis, pericardial effusion, cardiac tamponade, chronic pericarditis and relapsing pericarditis. In part II, we will focus on the knowledge and management of pericardial involvement in chylous pericardial effusion cholesterol pericarditis, radiation pericarditis, pericardial involvement in systemic inflammatory diseases, autoreactive pericarditis, pericarditis in renal failure, pericardial constriction and effusive constrictive pericarditis.
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Affiliation(s)
- Panupong Jiamsripong
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Scottsdale, AZ 85259, USA.
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178
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Rezaian GR, Poor-Moghaddas M, Kojuri J, Rezaian S, Liaghat L, Zare N. Atrial fibrillation in patients with constrictive pericarditis: the significance of pericardial calcification. Ann Noninvasive Electrocardiol 2009; 14:258-61. [PMID: 19614637 DOI: 10.1111/j.1542-474x.2009.00307.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Although atrial fibrillation (AF) is commonly encountered in patients with constrictive pericarditis (CP), little has been done to clarify its associated predisposing factors. Our aim was to evaluate the association of age, gender, disease duration, and pericardial calcification with AF in these patients. METHODS The medical records of 44 patients with CP were reviewed. There were 13 (29.5%) with AF and 31 (70.5%) with sinus rhythm. The two groups were compared for demographic variables, disease duration, and the presence of pericardial calcification. RESULTS The male-to-female ratio was 3.4:1. Calcification was seen in 11 (25%) of the entire group. AF was much more common in those with calcification than those with sinus rhythm (odds ratio, 7.87 [95% CI, 1.73-35.78], P=0.008). There was no association between the presence of AF and the age (P=0.156) or gender (P approximately 1.00). Logistic regression, however, showed that the chance of developing AF increased by 27% by each year of increase in disease duration (P=0.025). CONCLUSION It seems that in patients with CP, the presence of pericardial calcification and the increasing disease duration are associated with a higher chance of developing AF.
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Affiliation(s)
- Gholam R Rezaian
- Department of Medicine (Cardiology), Shiraz University of Medical Sciences, Shiraz, Iran.
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179
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180
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Abstract
Magnetic resonance is known to be a superior modality for the evaluation of pericardial disease and intracardiac masses because of its unmatched capacity for tissue characterization and high spatial resolution. New real-time sequences complement the standard morphologic imaging of the pericardium with dynamic image acquisitions that also can provide hemodynamic information indicative of constriction. Magnetic resonance also is becoming increasingly recognized as a superior modality for the detection and characterization of intracardiac thrombus. This article reviews the use of magnetic resonance imaging for the evaluation of pericardial disease and the detection of intracardiac thrombus, with particular emphasis on the newer pulse sequences currently available for cardiac imaging.
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Affiliation(s)
- John D Grizzard
- Non-invasive Cardiovascular Imaging, Department of Radiology, Virginia Commonwealth University Medical Center, Richmond, VA 23298-0615, USA.
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181
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Overlooked Constrictive Pericarditis as a Cause of Relapsing Ascites and Impairment of Renal Allograft Function. Transplant Proc 2009; 41:1949-50. [DOI: 10.1016/j.transproceed.2009.02.083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Accepted: 02/09/2009] [Indexed: 11/22/2022]
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182
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Bogaert J, Francone M. Cardiovascular magnetic resonance in pericardial diseases. J Cardiovasc Magn Reson 2009; 11:14. [PMID: 19413898 PMCID: PMC2685792 DOI: 10.1186/1532-429x-11-14] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Accepted: 05/04/2009] [Indexed: 02/06/2023] Open
Abstract
The pericardium and pericardial diseases in particular have received, in contrast to other topics in the field of cardiology, relatively limited interest. Today, despite improved knowledge of pathophysiology of pericardial diseases and the availability of a wide spectrum of diagnostic tools, the diagnostic challenge remains. Not only the clinical presentation may be atypical, mimicking other cardiac, pulmonary or pleural diseases; in developed countries a shift for instance in the epidemiology of constrictive pericarditis has been noted. Accurate decision making is crucial taking into account the significant morbidity and mortality caused by complicated pericardial diseases, and the potential benefit of therapeutic interventions. Imaging herein has an important role, and cardiovascular magnetic resonance (CMR) is definitely one of the most versatile modalities to study the pericardium. It fuses excellent anatomic detail and tissue characterization with accurate evaluation of cardiac function and assessment of the haemodynamic consequences of pericardial constraint on cardiac filling. This review focuses on the current state of knowledge how CMR can be used to study the most common pericardial diseases.
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Affiliation(s)
- Jan Bogaert
- Department of Radiology, UZ Leuven, B-3000 Leuven, Belgium
| | - Marco Francone
- Department of Radiology, University of La Sapienza, Rome, Italy
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183
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Canadian Cardiovascular Society Consensus Conference guidelines on heart failure, update 2009: diagnosis and management of right-sided heart failure, myocarditis, device therapy and recent important clinical trials. Can J Cardiol 2009; 25:85-105. [PMID: 19214293 DOI: 10.1016/s0828-282x(09)70477-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The Canadian Cardiovascular Society published a comprehensive set of recommendations on the diagnosis and management of heart failure in January 2006. Based on feedback obtained through a national program of heart failure workshops and through active solicitation of stakeholders, several topics were identified because of their importance to the practicing clinician. Topics chosen for the present update include best practices for the diagnosis and management of right-sided heart failure, myocarditis and device therapy, and a review of recent important or landmark clinical trials. These recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. The present update has been written from a clinical perspective to provide a user-friendly and practical approach. Specific clinical questions that are addressed include: What is right-sided heart failure and how should one approach the diagnostic work-up? What other clinical entities may masquerade as this nebulous condition and how can we tell them apart? When should we be concerned about the presence of myocarditis and how quickly should patients with this condition be referred to an experienced centre? Among the myriad of recently published landmark clinical trials, which ones will impact our standards of clinical care? The goals are to aid physicians and other health care providers to optimally treat heart failure patients, resulting in a measurable impact on patient health and clinical outcomes in Canada.
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184
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Anderson CA, Rodriguez E, Shammas RL, Kypson AP. Early Constrictive Epicarditis After Coronary Artery Bypass Surgery. Ann Thorac Surg 2009; 87:642-3. [DOI: 10.1016/j.athoracsur.2008.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Revised: 06/24/2008] [Accepted: 07/09/2008] [Indexed: 10/21/2022]
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185
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Shimamoto K, Koike N, Mizuochi K, Honma M, Kasai Y, Sakai A, Fujita E, Kawana M. Characteristics of acute congestive heart failure with normal ejection fraction and less elevated B-type natriuretic peptide. BMC Cardiovasc Disord 2009; 9:2. [PMID: 19166616 PMCID: PMC2636755 DOI: 10.1186/1471-2261-9-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 01/24/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heterogeneity in B-type natriuretic peptide (BNP) levels, especially among individuals with acute heart failure with normal left ventricular ejection fraction (HFNEF), can cause confusion in interpreting results. We investigated the characteristics of cases of acute HFNEF with only modestly elevated BNP. METHODS One hundred forty-two patients with acute or acute exacerbation of chronic HFNEF were divided into two groups by BNP level: BNP < 100 pg/ml (NB group, n = 45) and BNP > or = 100 pg/ml (B group, n = 97). We compared clinical findings, echocardiography results, and neurohormonal factors between these two groups. RESULTS In the NB group, a history of open-heart surgery (OHS) was more frequent (71% vs. 22%, p < 0.0001) and hypertension was less frequent (p = 0.0005). Left atrial diameter (LAd) was higher (p = 0.0026), while interventricular septal thickness, posterior wall thickness, relative wall thickness, left ventricular mass index were lower (p = 0.0005, p = 0.0225, p = 0.0114, p = 0.0051, respectively) in the NB group. In patients with HFNEF, a history of OHS remained an independent predictor of BNP level (< 100 pg/ml) after adjustment for hypertension, age, LAd, and interventricular septal thickness (odds ratio 3.6, p = 0.0252). CONCLUSION We found associations between acute HFNEF with less elevated BNP and a history of OHS. In a patient suspected of HFNEF, a history of OHS is considered diagnostic evidence of presence of diastolic heart failure when plasma levels of BNP are less elevated.
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Affiliation(s)
- Ken Shimamoto
- Department of Cardiology, Tokyo Women's Medical University Aoyama Hospital, Tokyo, Japan.
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186
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Dal-Bianco JP, Sengupta PP, Mookadam F, Chandrasekaran K, Tajik AJ, Khandheria BK. Role of Echocardiography in the Diagnosis of Constrictive Pericarditis. J Am Soc Echocardiogr 2009; 22:24-33; quiz 103-4. [DOI: 10.1016/j.echo.2008.11.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Indexed: 10/21/2022]
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187
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Pericardial Effusion, Tamponade, and Constriction. Echocardiography 2009. [DOI: 10.1007/978-1-84882-293-1_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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188
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Burns N, Shriki JE, Farvid AM, El-Sherief KE, Cunningham MJ, Colletti PM, Shinbane J. Calcific constrictive pericarditis demonstrated on 99mTc-MDP bone scintigraphy. J Radiol Case Rep 2009; 3:11-5. [PMID: 22470658 DOI: 10.3941/jrcr.v3i5.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors present a case of calcific constrictive pericarditis, imaged with bone scintigraphy. The patient presented with three months of shortness of breath, chest pain, and chest tightness during exercise, among other nonspecific symptoms. Although the diagnosis was made based on chest radiography and cardiac MRI, bone scintigraphy was used to corroborate the diagnosis of calcific constrictive pericarditis. Bone scintigraphy showed a pattern of tracer accumulation consistent with pericardial uptake. Calcific constrictive pericarditis was also confirmed at the time of surgery.
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Affiliation(s)
- Natalie Burns
- USC Keck School of Medicine, Los Angeles, California, USA
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189
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Nomura T, Keira N, Urakabe Y, Naito D, Nakayama M, Kido A, Kanemasa H, Matsubara H, Tatsumi T. Chronic pericardial constriction induced severe ischemic hepatitis manifesting as hypoglycemic attack. Circ J 2008; 73:183-6. [PMID: 19001747 DOI: 10.1253/circj.cj-07-0881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Ischemic hepatitis, otherwise known as "shock liver", is characterized by a massive, but transient increase in serum transaminase levels, usually associated with cardiac failure. A patient who did not have a predisposition to hypoglycemia was discovered at home with disturbed consciousness caused by hypoglycemia. She had been diagnosed as having constrictive pericarditis several years earlier and had developed ischemic hepatitis. Though the high serum transaminase levels were rapidly normalized, severe jaundice gradually developed and the patient finally died of multiple organ failure. Hypoglycemia, which is considered secondary to reduced gluconeogenesis in the exhausted liver, is a rare complication of constrictive pericarditis.
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Affiliation(s)
- Tetsuya Nomura
- Department of Cardiovascular Medicine, Nantan General Hospital, Nantan, Japan.
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190
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Misselt AJ, Harris SR, Glockner J, Feng D, Syed IS, Araoz PA. MR imaging of the pericardium. Magn Reson Imaging Clin N Am 2008; 16:185-99, vii. [PMID: 18474326 DOI: 10.1016/j.mric.2008.02.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Imaging of the pericardium requires understanding of anatomy and the normal and abnormal physiology of the pericardium. MR imaging is well-suited for answering clinical questions regarding suspected pericardial disease. Pericardial diseases that may be effectively imaged with MR imaging include pericarditis, pericardial effusion, cardiac-pericardial tamponade, constrictive pericarditis, pericardial cysts, absence of the pericardium, and pericardial masses. Although benign and malignant primary tumors of the pericardium may be occasionally encountered, the most common etiology of a pericardial mass is metastatic disease.
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Affiliation(s)
- Andrew J Misselt
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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191
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Abstract
Constrictive pericarditis (CP) is characterized by scarring and loss of elasticity of the pericardium, resulting in external impedance of cardiac filling. In the developed world, CP is most frequently encountered as a consequence of previous cardiac surgery, thoracic irradiation, viral or idiopathic causes. Tuberculosis still remains a common cause of CP in the developing world, immigrants from underdeveloped nations, and immunosuppressed patients. Clinical signs and symptoms of right heart failure coupled with risk factors for pericardial disease should raise suspicion for CP. Echocardiographic evaluation and often cardiac catheterization are essential components of accurate diagnosis of CP. Enhanced interventricular dependence, with respiratory variation in the ventricular pressures, and ventricular discordance are the pathophysiologic hallmarks of CP. Imaging findings such as increased pericardial thickness or pericardial calcification on computed tomography can be supportive, but are not necessary for the diagnosis of CP. Pericardiectomy remains the most effective therapy for symptomatic CP.
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Affiliation(s)
- Partho P Sengupta
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, USA
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192
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Johnson KT, Julsrud PR, Johnson CD. Constrictive pericarditis at abdominal CT: a commonly overlooked diagnosis. ACTA ACUST UNITED AC 2008; 33:349-52. [PMID: 17510764 DOI: 10.1007/s00261-007-9246-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate findings at abdominal computed tomography (CT) in patients with proven constrictive pericarditis. METHODS The medical records of 25 patients with surgically proven constrictive pericarditis and abdominal CT examinations within 30 days of operation were reviewed. Clinical symptoms, laboratory findings and prospective CT findings were collated. The CT examinations were also retrospectively reviewed in an unblinded fashion. RESULTS Direct CT findings of constrictive pericarditis with an abnormal pericardium were present in 23/25 patients. Only 9 of 25 (36%) patients were detected prospectively. Findings on retrospective review included pericardial calcification (10/25, 40%) or thickening (13/25, 52%), dilated IVC (20/25), dilated hepatic veins (14/25), ascites (14/25), mesenteric soft tissue stranding (12/25), mottled enhancement of the hepatic parenchyma (8/25), and cirrhosis (6/25). Anemia was present in (17/25), and an elevated AST levels occurred in 48% (12/25) of patients. The most common abdominal symptoms were pain (4/12), diarrhea (4/12), distention (3/12), and bloating (1/12). CONCLUSIONS Constrictive pericarditis can present with vague abdominal symptoms. Anemia and elevated liver function tests are common laboratory abnormalities. Indirect CT findings of dilated IVC and/or hepatic veins, ascites, or cirrhosis should prompt inspection of the pericardium. In the majority of cases an abnormal pericardium could be identified (thickened, calcified or both).
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Affiliation(s)
- Kristina T Johnson
- Department of Radiology, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA
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193
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Srinivasan N, Gupta R, Garrison M, Blevins S. Heart in a hard cage: startling calcific constrictive pericarditis. ACTA ACUST UNITED AC 2008; 14:161-3. [PMID: 18550929 DOI: 10.1111/j.1751-7133.2008.08025.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Nandakumar Srinivasan
- Department of Internal Medicine, Health Science Center, University of Oklahoma, Oklahoma City, OK, USA
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194
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Épanchement pleural gauche massif révélateur d’une péricardite constrictive idiopathique. Rev Mal Respir 2008; 25:591-5. [DOI: 10.1016/s0761-8425(08)71616-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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195
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Masci PG, Dymarkowski S, Bogaert J. The role of cardiovascular magnetic resonance in the diagnosis and management of cardiomyopathies. J Cardiovasc Med (Hagerstown) 2008; 9:435-49. [DOI: 10.2459/jcm.0b013e32827ab49f] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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196
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Kilicaslan F, Erikci AA, Kirilmaz A, Ulusoy E, Cebeci B, Ozturk A, Dincturk M. Rapid normalization of a highly thickened pericardium by chemotherapy in a patient with T-cell acute lymphoblastic lymphoma. Clin Cardiol 2008; 32:E52-4. [PMID: 18412145 DOI: 10.1002/clc.20272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The most common tumor that affects the pericardium is malign lymphoma. T-cell lymphoblastic lymphoma (TLL) is a rare type of malign lymphomas. In this manuscript, we are reporting a patient with TLL with pericardial involvement diagnosed incidentally during the evaluation of pleural effusion. Echocardiographic examination showed thickened pericardium and pericardial effusion. The pericardial thickness was found to be 13 mm by computerized tomography and confirmed by echocardiography. The patient had systemic chemotherapy for TLL. On day 30 of chemotherapy, computerized tomography of the thorax and echocardiographic examination revealed normal pericardial thickness and minimal pericardial effusion.
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Affiliation(s)
- Fethi Kilicaslan
- Department of Cardiology, GATA Haydarpasa Training Hospital, Istanbul, Turkey.
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197
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Shankar SM, Marina N, Hudson MM, Hodgson DC, Adams MJ, Landier W, Bhatia S, Meeske K, Chen MH, Kinahan KE, Steinberger J, Rosenthal D. Monitoring for cardiovascular disease in survivors of childhood cancer: report from the Cardiovascular Disease Task Force of the Children's Oncology Group. Pediatrics 2008; 121:e387-96. [PMID: 18187811 DOI: 10.1542/peds.2007-0575] [Citation(s) in RCA: 201] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Curative therapy for childhood cancer has improved significantly in the last 2 decades such that, at present, approximately 80% of all children with cancer are likely to survive > or = 5 years after diagnosis. Prevention, early diagnosis, and treatment of long-term sequelae of therapy have become increasingly more significant as survival rates continue to improve. Cardiovascular disease is a well-recognized cause of increased late morbidity and mortality among survivors of childhood cancer. The Children's Oncology Group Late Effects Committee and Nursing Discipline and Patient Advocacy Committee have recently developed guidelines for follow-up of long-term survivors of pediatric cancer. A multidisciplinary task force critically reviewed the existing literature to evaluate the evidence for the cardiovascular screening recommended by the Children's Oncology Group guidelines. In this review we outline the clinical manifestations of late cardiovascular toxicities, suggest modalities and frequency of monitoring, and address some of the controversial and unresolved issues regarding cardiovascular disease in childhood cancer survivors.
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Affiliation(s)
- Sadhna M Shankar
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee 37232-6310, USA.
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198
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Talreja DR, Nishimura RA, Oh JK, Holmes DR. Constrictive pericarditis in the modern era: novel criteria for diagnosis in the cardiac catheterization laboratory. J Am Coll Cardiol 2008; 51:315-9. [PMID: 18206742 DOI: 10.1016/j.jacc.2007.09.039] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Revised: 08/30/2007] [Accepted: 09/11/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study sought to determine the clinical utility of a new catheterization criterion for the diagnosis of constrictive pericarditis (CP). BACKGROUND The finding of early rapid filling and equalization of end-diastolic pressures obtained by cardiac catheterization are necessary for the diagnosis of CP, but these findings are also present in patients with restrictive myocardial disease (RMD). Enhanced ventricular interaction is unique to CP. METHODS High-fidelity intracardiac pressure waveforms from 100 consecutive patients undergoing hemodynamic catheterization for diagnosis of CP versus RMD were examined. Fifty-nine patients had surgically documented CP and comprised group 1; the remaining 41 patients with RMD comprised group 2. The ratio of the right ventricular to left ventricular systolic pressure-time area during inspiration versus expiration (systolic area index) was used as a measurement of enhanced ventricular interaction. RESULTS There were statistically significant differences in the conventional catheterization criteria between CP and RMD, but the predictive accuracy of any of the criteria was <75%. The systolic area index had a sensitivity of 97% and a predictive accuracy of 100% for the identification of patients with surgically proven CP. CONCLUSIONS The ratio of right ventricular to left ventricular systolic area during inspiration and expiration is a reliable catheterization criterion for differentiating CP from RMD, which incorporates the concept of enhanced ventricular interdependence.
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Affiliation(s)
- Deepak R Talreja
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA
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199
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Affiliation(s)
- Damon M Kwan
- Department of Medicine, California Pacific Medical Center, San Francisco, California 94115, USA.
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200
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Abstract
The human immunodeficiency virus (HIV) epidemic has been associated with an increase in all forms of extrapulmonary tuberculosis including tuberculous pericarditis. Tuberculosis is responsible for approximately 70% of cases of large pericardial effusion and most cases of constrictive pericarditis in developing countries, where most of the world's population live. However, in industrialized countries, tuberculosis accounts for only 4% of cases of pericardial effusion and an even smaller proportion of instances of constrictive pericarditis. Tuberculous pericarditis is a dangerous disease with a mortality of 17% to 40%; constriction occurs in a similar proportion of cases after tuberculous pericardial effusion. Early diagnosis and institution of appropriate therapy are critical to prevent mortality. A definite or proven diagnosis is based on demonstration of tubercle bacilli in pericardial fluid or on histologic section of the pericardium. A probable or presumed diagnosis is based on proof of tuberculosis elsewhere in a patient with otherwise unexplained pericarditis, a lymphocytic pericardial exudate with elevated biomarkers of tuberculous infection, and/or appropriate response to a trial of antituberculosis chemotherapy. Treatment consists of 4-drug therapy (isoniazid, rifampicin, pyrazinamide, and ethambutol) for 2 months followed by 2 drugs (isoniazid and rifampicin) for 4 months regardless of HIV status. It is uncertain whether adjunctive corticosteroids are effective in reducing mortality or pericardial constriction, and their safety in HIV-infected patients has not been established conclusively. Surgical resection of the pericardium is indicated for those with calcific constrictive pericarditis or with persistent signs of constriction after a 6 to 8 week trial of antituberculosis treatment in patients with noncalcific constrictive pericarditis.
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MESH Headings
- AIDS-Related Opportunistic Infections/complications
- AIDS-Related Opportunistic Infections/diagnosis
- AIDS-Related Opportunistic Infections/drug therapy
- AIDS-Related Opportunistic Infections/epidemiology
- AIDS-Related Opportunistic Infections/microbiology
- AIDS-Related Opportunistic Infections/surgery
- Adrenal Cortex Hormones/therapeutic use
- Antitubercular Agents/therapeutic use
- Echocardiography
- Electrocardiography
- Humans
- Mycobacterium tuberculosis
- Pericardial Effusion/drug therapy
- Pericardial Effusion/microbiology
- Pericardial Effusion/pathology
- Pericardial Effusion/surgery
- Pericardiectomy
- Pericardiocentesis
- Pericarditis, Constrictive/drug therapy
- Pericarditis, Constrictive/microbiology
- Pericarditis, Constrictive/pathology
- Pericarditis, Constrictive/surgery
- Pericarditis, Tuberculous/complications
- Pericarditis, Tuberculous/diagnosis
- Pericarditis, Tuberculous/drug therapy
- Pericarditis, Tuberculous/epidemiology
- Pericarditis, Tuberculous/microbiology
- Pericarditis, Tuberculous/surgery
- Treatment Outcome
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Affiliation(s)
- Faisal F Syed
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
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