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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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202
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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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203
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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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204
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Grizzard JD, Ang GB. Magnetic Resonance Imaging of Pericardial Disease and Cardiac Masses. Magn Reson Imaging Clin N Am 2007; 15:579-607, vi. [DOI: 10.1016/j.mric.2007.08.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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205
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Abstract
The pericardium serves many important functions, but it is not essential for life. Pericardial heart disease comprises only pericarditis and its complications, tamponade and constriction, and congenital lesions. However, the pericardium is affected by virtually every category of disease. The critical care physician is thus likely to encounter the patient with pericardial disease in a variety of settings, either as an isolated phenomenon or as a complication of a variety of systemic disorders, trauma, or certain drugs. Echocardiography is the primary tool for diagnosing and quantifying pericardial effusions, and in the context of the clinical presentation, a thorough understanding of M-mode, two-dimensional, and Doppler findings can help not only to identify patients with impending tamponade, but also to suggest a diagnosis of constrictive pericarditis. This article reviews the pathogenesis and diagnosis of pericardial heart disease, focusing on the diagnostic utility of echocardiography, with an emphasis on those areas of greatest interest to the intensivist.
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Affiliation(s)
- Brian D Hoit
- Department of Medicine, University Hospitals of Cleveland and Case Western Reserve University, Cleveland, OH, USA.
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206
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207
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Abstract
Our goal is to provide a detailed review of veno-occlusive disease (VOD), Budd-Chiari syndrome (BCS), and congestive hepatopathy (CH), all of which results in hepatic venous outflow obstruction. This is the first article in which all three syndromes have been reviewed, enabling the reader to compare the characteristics of these disorders. The histological findings in VOD, BCS, and CH are almost identical: sinusoidal congestion and cell necrosis mostly in perivenular areas of hepatic acini which eventually leads to bridging fibrosis between adjacent central veins. Tender hepatomegaly with jaundice and ascites is common to all three conditions. However, the clinical presentation depends mostly on the extent and rapidity of the outflow obstruction. Although the etiology and treatment are completely different in VOD, BCS, and CH; the similarities in clinical manifestations and liver histology may suggest a common mechanism of hepatic injury and adaptation in response to increased sinusoidal pressure.
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Affiliation(s)
- Ulas-Darda Bayraktar
- Department of Internal Medicine, Interfaith Medical Center, 229 Parkville Ave Apt# 4B, Brooklyn, NY 11230, United States.
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208
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Abstract
MRI is known to be a superior modality for evaluating pericardial disease and masses because of its unmatched capacity for tissue characterization and high spatial resolution. New real-time sequences now complement the standard morphologic imaging of the pericardium with dynamic image acquisitions that also can provide hemodynamic information indicative of constriction. In the evaluation of masses, recently developed rapid imaging sequences have shortened examination times and improved lesion characterization. The full spectrum of pericardial disease and cardiac masses is reviewed, and the role of MRI explored.
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Affiliation(s)
- John D Grizzard
- Department of Radiology, Noninvasive Cardiovascular Imaging, Virginia Commonwealth University Medical Center, 1250 East Marshall Street, Post Office Box 980615, Richmond, VA 23298, USA.
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209
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Hoit BD. Treatment of Pericardial Disease. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50051-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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210
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Cardiovascular Magnetic Resonance Imaging. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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211
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Launay D, Lambert M, Hachulla E, De Groote P, Remy-Jardin M, Queyrel V, Morell-Dubois S, Charlanne H, Cortot A, Hatron PY. Entéropathie exsudative révélant une péricardite chronique constrictive idiopathique. Rev Med Interne 2007; 28:38-41. [PMID: 17140707 DOI: 10.1016/j.revmed.2006.10.320] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Revised: 09/29/2006] [Accepted: 10/19/2006] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The cause of protein-losing enteropathy is sometimes difficult to establish. It can be rarely due to a constrictive pericarditis. EXEGESIS We report a patient presenting a protein-losing enteropathy revealing a constrictive pericarditis. CONCLUSION Chronic pericarditis should be evoked in case of unexplained protein-losing enteropathy. Echocardiography can sometimes be normal. Therefore, chest computed tomography scan or cardiac MRI followed by confirmation right heart catheterization should be performed in case of persistent unexplained protein-losing enteropathy.
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Affiliation(s)
- D Launay
- Service de médecine interne, centre national de référence des atteintes vasculaires de la sclérodermie, hôpital Claude-Huriez, CHRU de Lille, université Lille-II, rue Michel-Polonovski, 59037 Lille cedex, France.
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212
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Bergman M, Vitrai J, Salman H. Constrictive pericarditis: A reminder of a not so rare disease. Eur J Intern Med 2006; 17:457-64. [PMID: 17098587 DOI: 10.1016/j.ejim.2006.07.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Revised: 05/11/2006] [Accepted: 07/03/2006] [Indexed: 12/25/2022]
Abstract
Constrictive pericarditis is a rare condition characterized by clinical signs of right heart failure subsequent to loss of pericardial compliance. The etiology of constrictive pericarditis has changed during the last decades in developed countries. While, in the past, tuberculosis and idiopathic pericardial constriction were the prevalent causes of the disease, cardiac surgery has become one of the main reasons for its development in recent years. However, cases defined as idiopathic constrictive pericarditis are still observed. In addition to the classical chronic and subacute forms, new presentations, such as effusive-constrictive, localized, transient, occult, and constrictive pericarditis with normal pericardial thickness, have been described. Although conservative treatment may alleviate the patient's symptoms, pericardiectomy remains the only definitive treatment for the disease. It is worth noting that the sooner the diagnosis of pericardial constriction is established, the better the outcome is. The pathophysiological features, clinical findings, diagnostic tools, and therapeutic approach to constrictive pericarditis are detailed in this review.
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Affiliation(s)
- Michael Bergman
- Department of Internal Medicine "C", Rabin Medical Center, Golda Campus (Hasharon), Petah-Tiqva, Israel; The Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
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213
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Affiliation(s)
- Warren J Manning
- Beth Israel Deaconess Medical Center, Cardiovascular Division, Harvard Medical School, Boston, Massachusetts 02215, USA.
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214
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Akhter MW, Nuño IN, Rahimtoola SH. Constrictive pericarditis masquerading as chronic idiopathic pleural effusion: importance of physical examination. Am J Med 2006; 119:e1-4. [PMID: 16828612 DOI: 10.1016/j.amjmed.2005.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Revised: 09/01/2005] [Accepted: 09/03/2005] [Indexed: 11/17/2022]
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215
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216
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Affiliation(s)
- William C Little
- Cardiology Section, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1045, USA.
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217
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Demiralp E, Ulusoy RE, Kirilmaz A, Cebeci BS, Kucukarslan N, Ozmen N, Aparci M. Comorbidity of constrictive pericarditis and hemophilia A. Med Princ Pract 2006; 15:228-31. [PMID: 16651841 DOI: 10.1159/000092187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2004] [Accepted: 03/23/2005] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To report a case of comorbidity of constrictive pericarditis and hemophilia A. CLINICAL PRESENTATION AND INTERVENTION A 21-year-old male with hemophilia A was referred to our clinic and was examined with the subsequent evaluation of shortness of breath, leg edema and ascites. Clinical and laboratory examinations were performed. The results were consistent with constrictive pericarditis (CP), and the symptoms were completely relieved following institution of medical therapy. CONCLUSION Because hemophilia A and pericarditis may be coincidentally present clinical conditions, avoidance of surgical procedures in hemophilic patients is preferable unless the resolution of the symptoms of pericarditis cannot be effected by medical therapy.
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Affiliation(s)
- Ergun Demiralp
- Department of Cardiology, Gata Haydarpasa Teaching Hospital, Istanbul, Turkey
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218
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Hong JM, Lee JY, Kim SJ, Jang GY, Shim WS. A case of constrictive pericarditis presenting with protein-losing enteropathy. KOREAN JOURNAL OF PEDIATRICS 2006. [DOI: 10.3345/kjp.2006.49.8.898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jeong Mi Hong
- Department of Pediatrics, College of Medicine, Kyunghee University, Seoul, Korea
| | - Jae Young Lee
- Department of Pediatric Cardiology, Sejong Heart Institute, Sejong General Hospital, Bucheon, Korea
| | - Soo Jin Kim
- Department of Pediatric Cardiology, Sejong Heart Institute, Sejong General Hospital, Bucheon, Korea
| | - Gi Young Jang
- Department of Pediatric Cardiology, Sejong Heart Institute, Sejong General Hospital, Bucheon, Korea
| | - Woo Sup Shim
- Department of Pediatric Cardiology, Sejong Heart Institute, Sejong General Hospital, Bucheon, Korea
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219
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Macias WL, Kabrhel C, Nadel ES, Brown DFM. Pleuritic chest pain and exertional dyspnea. J Emerg Med 2005; 29:467-73. [PMID: 16243209 DOI: 10.1016/j.jemermed.2005.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Wendy L Macias
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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220
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Francone M, Dymarkowski S, Kalantzi M, Rademakers FE, Bogaert J. Assessment of ventricular coupling with real-time cine MRI and its value to differentiate constrictive pericarditis from restrictive cardiomyopathy. Eur Radiol 2005; 16:944-51. [PMID: 16228208 DOI: 10.1007/s00330-005-0009-0] [Citation(s) in RCA: 138] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2005] [Revised: 07/24/2005] [Accepted: 08/19/2005] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to evaluate the use of respiratory-related ventricular coupling to differentiate patients with constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM). In 18 histologically proven cases of CP, 6 patients with inflammatory pericarditis (IP), 15 RCM patients and 17 normal subjects, real-time cine MRI was performed in the cardiac short-axis (basal half of the ventricles) during operator-guided deep respiration. The images were analyzed for ventricular septal position and shape during early ventricular filling. Early diastolic septal inversion (I) or flattening (F) was found in all CP (I:15,F:3), and in all IP (I:2,F:4), but seldom in normals (F:1) and not in RCM. The septal abnormalities occurred at the onset of inspiration and rapidly disappeared with the next heartbeats. The amount of ventricular coupling was evaluated by quantifying the difference in the maximal septal excursion between inspiration and expiration. This parameter, normalized to the biventricular diameter, was significantly larger in CP (20.0+/-4.5%, P<0.0001) and IP (14.8+/-3.2%, P<0.0001) patients than in normals (7.0+/-2.4%), whereas RCM patients had a trend toward decreased excursion (4.2+/-1.7%, P=0.11). A cut-off value of 11.8% (mean normals +2 SD) enabled to differentiate CP patients from normals and RCM patients completely. Real-time cine MRI can easily depict increased ventricular coupling, which may be helpful to better differentiate between CP and RCM patients, especially in patients with normal or minimally thickened pericardium. The increase in coupling in IP patients is likely caused by decreased compliance of the inflamed pericardial layers.
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Affiliation(s)
- Marco Francone
- Department of Radiology and Cardiology, Gasthuisberg University Hospital, Leuven, Germany
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221
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Marcu CB, Caracciolo E, Donohue T. Rapid progression of pericardial calcification in a patient with end-stage renal disease. Catheter Cardiovasc Interv 2005; 65:43-6. [PMID: 15800878 DOI: 10.1002/ccd.20361] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Dialysis pericarditis is a relatively uncommon cause of pericardial constriction and may be found in patients with end-stage renal disease receiving adequate renal replacement therapy. We present a patient with end-stage renal disease maintained on chronic peritoneal dialysis who developed severe myopericardial calcification over a 2-month period demonstrated by sequential chest computed tomographic scanning. The characteristic hemodynamic findings of constrictive-effusive pericarditis, obtained during cardiac catheterization, are presented and discussed.
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Affiliation(s)
- Constantin B Marcu
- Section of Cardiology, Hospital of Saint Raphael-Yale University School of Medicine, 1450 Chapel Street, New Haven, CT 06511, USA.
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222
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Francone M, Dymarkowski S, Kalantzi M, Bogaert J. Real-time cine MRI of ventricular septal motion: a novel approach to assess ventricular coupling. J Magn Reson Imaging 2005; 21:305-9. [PMID: 15723377 DOI: 10.1002/jmri.20259] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The purpose of this study was to assess the feasibility of magnetic resonance imaging (MRI) to evaluate in real-time, the effects of respiration in ventricular septal motion and configuration in normal volunteers and cardiac patients. Real-time cine MRI studies, using the steady-state free precession (SSFP) technique, were performed in the cardiac short-axis during operator-guided deep inspiration and expiration in normal volunteers (N = 6), and in patients with constrictive pericarditis (CP; N = 6), restrictive cardiomyopathy (RCM; N = 4), chronic cor pulmonale (N = 5), and pericardial effusion. The respiratory effects on septal position and configuration during early ventricular filling were visually assessed. Results were compared with the short-axis breath-hold cine MRI studies, obtained at end-inspiration. In CP patients, onset of inspiration led to a leftward inversion in four of six patients and flattening of the septum in two of six patients during early ventricular filling. Septal abnormalities progressively disappeared during the following heartbeats. A similar pattern was found in one of six patients with pericardial effusion. The above pattern was absent in RCM patients. Although septal flattening during early inspiration was also found in two of six normal volunteers, flattening was minimal compared to that in CP patients. In all cor pulmonale patients, septal flattening or inversion was present, but this was not influenced by respiratory motion. Real-time cine MRI is a promising technique for determining the influence of respiration on septal motion and might be helpful in differentiating between different causes of impaired ventricular filling.
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Affiliation(s)
- Marco Francone
- Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium
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223
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Abstract
The pericardium envelopes the cardiac chambers and under physiological conditions exerts subtle functions, including mechanical effects that enhance normal ventricular interactions that contribute to balancing left and right cardiac outputs. Because the pericardium is non-compliant, conditions that cause intrapericardial crowding elevate intrapericardial pressure, which may be the mediator of adverse cardiac compressive effects. Elevated intrapericardial pressure may result from primary disease of the pericardium itself (tamponade or constriction) or from abrupt chamber dilatation (eg, right ventricular infarction). Regardless of the mechanism leading to increased intrapericardial pressure, the resultant pericardial constraint exerts adverse effects on cardiac filling and output. Constriction and restrictive cardiomyopathy share common pathophysiological and clinical features; their differentiation can be quite challenging. This review will consider the physiology of the normal pericardium and its dynamic interactions with the heart and review in detail the pathophysiology and clinical manifestations of cardiac tamponade, constrictive pericarditis, and restrictive cardiomyopathy.
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Affiliation(s)
- James A Goldstein
- Division of Cardiology, William Beaumont Hospital,3601 West Thirteen Mile Road, Royal Oak, MI 48073, USA,
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224
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Thatayatikom A, White AJ. Swollen uvula in an 18-year-old man with hypogammaglobulinemia. Ann Allergy Asthma Immunol 2004; 93:417-24. [PMID: 15562879 DOI: 10.1016/s1081-1206(10)61407-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Akaluck Thatayatikom
- Division of Immunology/Rheumatology, Department of Pediatrics, Saint Louis Children's Hospital and Washington University School of Medicine, St. Louis, Missouri 63110, USA
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225
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Afanasyeva M, Georgakopoulos D, Fairweather D, Caturegli P, Kass DA, Rose NR. Novel model of constrictive pericarditis associated with autoimmune heart disease in interferon-gamma-knockout mice. Circulation 2004; 110:2910-7. [PMID: 15505106 DOI: 10.1161/01.cir.0000147538.92263.3a] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Constrictive pericarditis represents a serious hemodynamic syndrome that may lead to heart failure. Studies of its pathophysiological mechanisms have been impeded by the lack of an animal model. METHODS AND RESULTS Cardiac myosin-induced experimental autoimmune myocarditis in interferon (IFN)-gamma-knockout (KO) mice results in increased cardiac inflammation and development of severe grossly detectable pericarditis. Using in vivo pressure-volume studies, we found that the acute phase of experimental autoimmune myocarditis in IFN-gamma-KO mice was characterized by reduced left ventricular (LV) volumes compared with wild-type mice. The KO mice exhibited a classic restrictive/constrictive phenotype with decreased cardiac output, increased chamber stiffness, preserved ejection fraction, and impaired diastolic filling, characterized by reduced deceleration time and pressure tracings showing the square root sign similar to that observed in clinical cases of constrictive pericarditis. This phenotype was not associated with the severity of myocarditis but correlated with the presence of grossly detectable adhesive pericarditis present only in the KO group and characterized by increased pericardial inflammation and fibrosis. Comparison of IFN-gamma-KO and wild-type mice matched for the severity of myocardial disease further confirmed that pericarditis, and not myocarditis, was responsible for smaller LV volumes, reduced cardiac output, increased cardiac stiffness, and increased peak filling rate adjusted for end-diastolic volumes in KO mice. CONCLUSIONS Autoimmune heart disease in IFN-gamma-KO mice results in increased pericardial inflammation and fibrosis, leading to constrictive phenotype during the acute phase of disease. It represents a novel animal model of constrictive pericarditis.
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Affiliation(s)
- Marina Afanasyeva
- Department of Pathology, Johns Hopkins Medical Intitutions, Baltimore, Md, USA.
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226
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Affiliation(s)
- Andrew Wang
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
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227
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Ohsawa M, Nakamura M, Pan LH, Shizuka T, Nakagawa JI, Ishida H, Ouchi M, Shiroto T, Hotta K, Sawai T, Hiramori K. Post-operative constrictive pericarditis complicated with lymphocytopenia and hypoglobulinemia. Intern Med 2004; 43:811-5. [PMID: 15497516 DOI: 10.2169/internalmedicine.43.811] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 71-year-old man who had a history of open chest surgery was admitted due to anasarca and bilateral pleural effusions. Although imaging modalities could not demonstrate any pericardial abnormalities, right-sided cardiac catheterization revealed 'dip and plateau' in diastolic pressure waveform. He was admitted frequently because of the episodic right-sided congestive heart failure and hypoproteinemia due to protein-losing enteropathy. The peripheral lymphocyte count and serum gamma-globulin concentration were gradually decreased, and finally showed lymphocytopenia and hypoglobulinemia. On the last admission, the patient showed extensive cellulitis on both legs, and he developed septicemia, and finally died due to septic shock. Post-mortem examination showed that both visceral and parietal layers of the pericardium adhered tightly with mediastinal fibrosis. This case report suggested that constrictive pericarditis should be considered even if there is a lack of typical abnormal pericardial imaging findings when patients have a history of open chest surgery and recurrent right-sided congestive heart failure. In addition, we should be aware of a serious outcome due to immune compromised conditions such as lymphocytopenia and dysglobulinemia in this disorder.
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Affiliation(s)
- Masaki Ohsawa
- Second Department of Internal Medicine, Iwate Medical University, Morioka
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228
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Ha JW, Ommen SR, Tajik AJ, Barnes ME, Ammash NM, Gertz MA, Seward JB, Oh JK. Differentiation of constrictive pericarditis from restrictive cardiomyopathy using mitral annular velocity by tissue Doppler echocardiography. Am J Cardiol 2004; 94:316-9. [PMID: 15276095 DOI: 10.1016/j.amjcard.2004.04.026] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2003] [Revised: 04/13/2004] [Accepted: 04/13/2004] [Indexed: 11/27/2022]
Abstract
This study evaluated the diagnostic role of early diastolic mitral annular velocity (E') by tissue Doppler echocardiography for differentiating constrictive pericarditis from restrictive cardiomyopathy (primary restrictive cardiomyopathy and cardiac amyloidosis). The study group consisted of 75 patients (53 men, 22 women; mean age 62 years, range 27 to 87). Of these, 23 patients had surgically confirmed constrictive pericarditis, 38 had biopsy-proved systemic amyloidosis and typical echocardiographic features of cardiac involvement, and 14 had primary restrictive cardiomyopathy. Standard mitral inflow characteristics were measured. Tissue Doppler echocardiography was used to measure E' at the septal annulus. E' was significantly higher in patients with constrictive pericarditis than in those with primary restrictive cardiomyopathy or cardiac amyloidosis (12.3 vs 5.1 cm/second, p <0.001). An E' cut-off value > or =8 cm/second resulted in 95% sensitivity and 96% specificity for the diagnosis of constrictive pericarditis. There was no overlap of E' between patients who had constrictive pericarditis and those who had cardiac amyloidosis. In a subgroup analysis of restrictive cardiomyopathy, E' of patients who had cardiac amyloidosis was significantly lower than that of patients who had primary restrictive cardiomyopathy (4.6 vs 6.3 cm/second, p <0.001). Thus, E' velocity can distinguish between constrictive pericarditis and restrictive cardiomyopathy with a specific cut-off value in patients with clinical and echocardiographic evidence of diastolic heart failure.
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Affiliation(s)
- Jong-Won Ha
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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229
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230
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Abstract
The diagnosis and therapy of pericardial diseases are still a physician's challenge. Advanced CT and MR imaging technologies can display the complete morphology of the heart and the pericardium and of the adjacent thoracic structures with a spatial and contrast resolution below 1 mm. All the macromorphologic determinants of pericardial constriction and their functional sequels may be identified by these remarkable technologies. A careful systematic image analysis defines not only a precise diagnosis but also determines the optimal surgical or conservative therapy for the individual patient and minimizes the risk of perisurgical mortality.
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Affiliation(s)
- Rainer Rienmüller
- Division of General Diagnostic Radiology, Interdisciplinary Cardiac Imaging Centre, Medical University of Graz, Auenbruggerplatz 9, Graz 8036, Austria.
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231
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Abstract
Pericarditis is a common disorder that has multiple causes and presents in various primary-care and secondary-care settings. New diagnostic techniques have improved the sampling and analysis of pericardial fluid and allow comprehensive characterisation of cause. Despite this advance, pericarditis is most commonly idiopathic, and radiation therapy, cardiac surgery, and percutaneous procedures have become important causes. Pericarditis is frequently self-limiting, and non-steroidal anti-inflammatory agents remain the first-line treatment for uncomplicated cases. Integrated use of new imaging methods facilitates accurate detection and management of complications such as pericardial effusion or constriction. Differentiation of constrictive pericarditis from restrictive cardiomyopathy remains a clinical challenge but is facilitated by tissue doppler and colour M-mode echocardiography. Most pericardial effusions can be safely managed with an echo-guided percutaneous approach. Pericardiectomy remains the definitive treatment for constrictive pericarditis and provides symptomatic relief in most cases. In the future, the pericardial space might become a conduit for treatments directed at the pericardium and myocardium.
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Affiliation(s)
- Richard W Troughton
- Department of Medicine, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand
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232
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Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y, Tomkowski WZ, Thiene G, Yacoub MH. Guía de Práctica Clínica para el diagnóstico y tratamiento de las enfermedades del pericardio. Versión resumida. Rev Esp Cardiol 2004; 57:1090-114. [PMID: 15544758 DOI: 10.1016/s0300-8932(04)77245-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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233
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Bass HW. The conservation and divergence of telomeric structures, effects, and functions. Cell Mol Life Sci 2003; 60:2281-2. [PMID: 14625674 PMCID: PMC11138656 DOI: 10.1007/s00018-003-3322-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- H W Bass
- Department of Biological Science, Florida State University, Tallahassee, Florida 32306-4370, USA.
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