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Barriales-Revilla L, Benites-Yshpilco L, Baltodano-Arellano R, Falcón-Quispe L, Cupe-Chacalcaje K, Cachicatari-Beltrán A, Lévano-Pachas G. [Imagen multimodal de la pericarditis constrictiva: reporte de un caso de cirrosis cardiaca]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2023; 4:109-113. [PMID: 38046233 PMCID: PMC10688404 DOI: 10.47487/apcyccv.v4i3.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/04/2023] [Indexed: 12/05/2023]
Abstract
Constrictive pericarditis is a rare cause of ascites and cardiac cirrhosis. We present the case of a 36-year-old male patient with a history of cirrhosis of unknown etiology, who consulted for refractory ascites, dyspnea, and lower limb swelling. Echocardiography determined constrictive pericarditis, which was corroborated by the findings of computed tomography. The clinical and hemodynamic worsening of the patient led to an emergency pericardiectomy with satisfactory recovery. This report shows a severe clinical consequence of constrictive pericarditis, cardiac cirrhosis, which was reversible with pericardial extirpation. Multimodal imaging was essential in the diagnosis of constrictive pericarditis.
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Affiliation(s)
- Lucía Barriales-Revilla
- Servicio de Cardiología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru. Servicio de Cardiología Hospital Guillermo Almenara Irigoyen, EsSalud Lima Peru
| | - Lindsay Benites-Yshpilco
- Servicio de Cardiología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru. Servicio de Cardiología Hospital Guillermo Almenara Irigoyen, EsSalud Lima Peru
| | - Roberto Baltodano-Arellano
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru. Universidad Nacional Mayor de San Marcos Facultad de Medicina Universidad Nacional Mayor de San Marcos Lima Peru
- Unidad de Imágenes Cardiacas, Servicio de Cardiología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru Unidad de Imágenes Cardiacas, Servicio de Cardiología Hospital Guillermo Almenara Irigoyen, EsSalud Lima Peru
| | - Luis Falcón-Quispe
- Unidad de Imágenes Cardiacas, Servicio de Cardiología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru Unidad de Imágenes Cardiacas, Servicio de Cardiología Hospital Guillermo Almenara Irigoyen, EsSalud Lima Peru
| | - Kelly Cupe-Chacalcaje
- Unidad de Imágenes Cardiacas, Servicio de Cardiología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru Unidad de Imágenes Cardiacas, Servicio de Cardiología Hospital Guillermo Almenara Irigoyen, EsSalud Lima Peru
| | - Angela Cachicatari-Beltrán
- Unidad de Imágenes Cardiacas, Servicio de Cardiología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru Unidad de Imágenes Cardiacas, Servicio de Cardiología Hospital Guillermo Almenara Irigoyen, EsSalud Lima Peru
| | - Gerald Lévano-Pachas
- Servicio de Cardiología, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru. Servicio de Cardiología Hospital Guillermo Almenara Irigoyen, EsSalud Lima Peru
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2
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Vaysblat M, Kang G, Panjwani B, Dastagir M, Roarke DT. Atypical Presentation of Constrictive Pericarditis With Constrictive Physiology on Cardiac MRI. Cureus 2023; 15:e41626. [PMID: 37575803 PMCID: PMC10412753 DOI: 10.7759/cureus.41626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Constrictive pericarditis (CP) is a disease primarily affecting the pericardial sac surrounding the heart. The constrictive physiology placed on the heart chambers can lead to clinical presentations mimicking heart failure and possibly primary liver disease. The diagnosis can often be missed and attributed to other etiologies until the patient undergoes extensive workup to rule out each potential etiology. Diagnosis can be delayed, leading to suboptimal outcomes and mortality rates. Here, we present a case of CP initially presenting with bilateral lower extremity and scrotal edema, initially attributed to alcoholic liver cirrhosis given the patient's history of alcohol abuse. Subsequent abdominal imaging found no evidence of cirrhosis, coupled with grossly normal echocardiogram that led to extensive workup and eventually the diagnosis of CP based on cardiac MRI. The patient later underwent pericardiectomy and made a full recovery. This case highlights the often ambiguous presentation of CP, the utility of cardiac MRI in diagnosis, and the need for specific criteria to help guide future diagnoses as imaging modalities continue to evolve.
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Affiliation(s)
| | | | | | - Manile Dastagir
- Internal Medicine, North Shore University Hospital, New York, USA
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3
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Grewal HK, Bansal M. Echocardiographic Differentiation of Pericardial Constriction and Left Ventricular Restriction. Curr Cardiol Rep 2022; 24:1599-1610. [PMID: 36040551 DOI: 10.1007/s11886-022-01774-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW Overlapping hemodynamics in constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM) often pose difficulties in establishing accurate diagnosis. Echocardiography is the first-line imaging modality used for this purpose, but no single echocardiographic parameter is sufficiently robust for distinguishing between the two conditions. The newer developments may improve the diagnostic accuracy of echocardiography in this setting. RECENT FINDINGS Recent studies have validated multiparametric algorithms, based on conventional echocardiographic parameters, which enable high sensitivity and specificity for distinguishing between CP and RCM. In addition, myocardial deformation analysis using speckle-tracking echocardiography has revealed distinct pattern of abnormalities in the two conditions. CP is characterized by impaired left ventricular apical rotation with relatively preserved longitudinal strain, esp. of ventricular and atrial septum. In contrast, RCM results in global and marked impairment of left ventricular longitudinal strain with initially preserved circumferential mechanics. Combining multiple echocardiographic parameters into step-wise algorithms and incorporation of myocardial deformation analysis help improve the diagnostic accuracy of echocardiography for distinguishing between CP and RCM. The use of machine-learning may allow easy integration of a wide range of echocardiographic and clinical parameters to permit accurate, automated diagnosis, with less dependence on the user expertise.
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Affiliation(s)
- Hardeep Kaur Grewal
- Medanta Heart Institute, Medanta - The Medicity, Gurgaon, Haryana, 122001, India
| | - Manish Bansal
- Medanta Heart Institute, Medanta - The Medicity, Gurgaon, Haryana, 122001, India.
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Chudgar PD, Burkule NJ, Kamat NV, Rege GM, Jantre MN. Myocardial Strain Imaging Using Feature Tracking Method of Cardiac MRI: Our Initial Experience of This Novel Parameter as an Additional Diagnostic Tool. Indian J Radiol Imaging 2022; 32:479-487. [DOI: 10.1055/s-0042-1748760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Background Left ventricular ejection fraction (LVEF) is used as quantitative parameter to evaluate myocardial function. However, interobserver variation, limited reproducibility, and dependence on pre-load and after-load reduces its accuracy. The fall in LVEF occurs very late, when myocardial dysfunction is already advanced. Myocardial strain measurements (especially global longitudinal strain) is a new parameter to detect myocardial dysfunction before derangements in LVEF. The aim of this article is to share our experience of this novel diagnostic tool.
Methods Feature tracking method of strain assessment is performed using routine long and short axis cine images of cardiac MRI (CMR). Dedicated post-processing CMR software can perform off-line analysis and provide results in form of color-coded maps, percentage values as well as strain over time curve for each myocardial segments.
Results Global longitudinal strain (GLS) is more sensitive than LVEF and can identify sub-clinical left ventricular (LV) dysfunction in various cardiomyopathies. It is also an important prognostic marker in serial assessment of heart failure patients. Regional differences in strain parameters can provide clues in hypertrophic cardiomyopathy as well as amyloidosis. GLS is recommended as routine measurement in patients undergoing chemotherapy to detect LV dysfunction prior to fall in LVEF. Strain imaging can be applied to guide placement of the LV pacing lead in patients receiving cardiac resynchronization therapy. More clinical data is needed to evaluate its role in ischemic heart disease.
Conclusion Strain imaging can identify LV dysfunction earlier than conventional methods and this opens a new perspective in risk stratification and therapeutic decision-making of various cardiac pathologies.
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Affiliation(s)
- Priya D. Chudgar
- Department of Radiology, Jupiter Hospital, Thane, Mumbai, Maharashtra, India
| | - Nitin J. Burkule
- Department of Radiology, Jupiter Hospital, Thane, Mumbai, Maharashtra, India
| | - Nikhil V. Kamat
- Department of Radiology, Jupiter Hospital, Thane, Mumbai, Maharashtra, India
| | - Gautam M. Rege
- Department of Radiology, Jupiter Hospital, Thane, Mumbai, Maharashtra, India
| | - Mansi N. Jantre
- Department of Radiology, Jupiter Hospital, Thane, Mumbai, Maharashtra, India
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5
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Saeed S, Haaverstad R, Blomberg B, Bleie Ø, Lunde T. Long-term echocardiographic follow-up of a patient with constrictive pericarditis treated with antituberculosis drugs and pericardiectomy. BMJ Case Rep 2021; 14:14/8/e244665. [PMID: 34446521 PMCID: PMC8395355 DOI: 10.1136/bcr-2021-244665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A middle-aged man presented to the Department of Medicine of our hospital due to exertional dyspnoea, ascites and peripheral oedema. He was later transferred to the Department of Heart Disease as his echocardiography indicated constrictive pericarditis, confirmed by cardiac MRI and cardiac catheterisation. After a thorough investigation, his constrictive pericarditis was assumed to be caused by tuberculosis. He was treated with antituberculosis therapy followed by successful surgical subtotal pericardiectomy, leading to immediate improvement of haemodynamics, regression of symptoms and recovery of cardiac function. The patient remained stable at 5-year echocardiographic follow-up with no evidence of diastolic dysfunction.
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Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Rune Haaverstad
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Bjørn Blomberg
- National Advisory Unit on Tropical Infectious Diseases, Haukeland Universitetssjukehus, Bergen, Norway .,Department of Clinical Science, Universitetet i Bergen, Bergen, Norway
| | - Øyvind Bleie
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Torbjørn Lunde
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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El Hennawy HM, Al Faifi AS, Al-Kawasmeh S, Salah NG, Albaba A. Serious Combination of Chronic Non Tamponade Uremic Pericardial Effusion, Hypotension, and Atrial Fibrillation on Living Donor Renal Transplantation: A Case Report and Review of Literature. Transplant Proc 2021; 53:2512-2516. [PMID: 34266653 DOI: 10.1016/j.transproceed.2021.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 05/13/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
Although pericardial effusions are not uncommon in patients with end-stage renal disease, uremic pericardial effusion (UPE) frequently remains unrecognized in the absence of clinical signs and symptoms. We present a case of post-living donor renal transplantation delayed graft function due to asymptomatic undiagnosed chronic nontamponade UPE. The patient developed dramatic intraoperative severe hypotension, electrolyte abnormalities, and atrial fibrillation. Prolonged intraoperative hypotension and allograft hypoperfusion caused mild acute tubular necrosis and postoperative delayed graft function that required 2 weeks to recover. The combination of chronic UPE, even without tamponade, hypotension, and atrial fibrillation could lead to significant hemodynamic instability during renal transplantation. More careful immediate pretransplantation cardiac evaluation and avoidance of intraoperative hypotension could prevent these serious consequences of silent UPE.s.
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Affiliation(s)
- Hany M El Hennawy
- Transplant Surgery Section, Surgery Department, Armed Forces Hospital-Southern Regions, Khamis Mushayt, Saudi Arabia.
| | - Abdullah S Al Faifi
- Transplant Surgery Section, Surgery Department, Armed Forces Hospital-Southern Regions, Khamis Mushayt, Saudi Arabia
| | - Shaher Al-Kawasmeh
- Department of Nephrology, Armed Forces Hospital-Southern Regions, Khamis Mushayt, Saudi Arabia
| | - Naeim G Salah
- Department of Nephrology, Armed Forces Hospital-Southern Regions, Khamis Mushayt, Saudi Arabia
| | - Assad Albaba
- Department of Anesthesiology, Armed Forces Hospital-Southern Regions, Khamis Mushayt, Saudi Arabia
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Malakan Rad E, Yaghmaei B, Ziaee V, Beirami F, Pouraliakbar H. Multimodality imaging of constrictive pericarditis in H syndrome. Echocardiography 2021; 38:1021-1032. [PMID: 33899966 DOI: 10.1111/echo.15027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/12/2021] [Accepted: 02/26/2021] [Indexed: 11/28/2022] Open
Abstract
This is the first report of constrictive pericarditis (CP) in a 16-year-old boy with H syndrome with pericardial involvement predominantly over the right ventricle with favorable response to anti-inflammatory treatment. H syndrome, first reported in 2008, is a new auto-inflammatory syndrome with multiorgan involvement due to mutation in the SLC29A3 gene. We described the echocardiographic characteristics of asymmetric pericardial involvement and presented the cardiac computed tomography angiographic and magnetic resonance imaging findings. We reviewed the echocardiographic signs of CP, introduced tricuspid E/A respiratory alternans as a novel echocardiographic sign of right ventricular dominant CP, and explained the underlying mechanism.
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Affiliation(s)
- Elaheh Malakan Rad
- Department of Pediatric Cardiology, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Yaghmaei
- Department of Pediatric Intensive Care, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Ziaee
- Department of Pediatrics, Tehran University of Medical Science, Tehran, Iran.,Children's Medical Center, Pediatric Center of Excellence, Tehran, Iran.,Pediatric Rheumatology Research Group, Rheumatology Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Farzaneh Beirami
- Department of Pediatric Intensive Care, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
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Xiao Y, Qiao W, Wang X, Sun L, Ren W. MiR-146a mediates TLR-4 signaling pathway to affect myocardial fibrosis in rat constrictive pericarditis model. J Thorac Dis 2021; 13:935-945. [PMID: 33717566 PMCID: PMC7947533 DOI: 10.21037/jtd-20-2716] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Myocardial fibrosis (MF) is thought to be associated with constrictive pericarditis (CP). miR-146a has been reported to be related to the survival of myocardial fibroblasts and related signal transduction pathways. The aim of this study was to investigate the expression of miR-146a in CP with MF and the activation of the Toll-like receptor 4 (TLR-4) signaling pathway, to understand the molecular mechanism of MF involvement in CP. Methods Thirty rats with different disease duration were randomly divided into three groups: an 8-week model group (CP-8W group), a 16-week model group (CP-16W group) model, and a normal control group (N group). After the CP model was established in the rats, the myocardial tissues were collected. The expression of miR-146a, the key factors of TLR-4 signaling pathway, including IL-1 receptor-associated kinase 1 (IRAK1), tumor necrosis factor receptor-associated factor 6 (TRAF6), nuclear factor-κB (NF-κB) and p-NF-κB, and the MF indicator α-SMA in myocardial tissue were detected. After treatment with lipopolysaccharide (LPS), primary cultured rat cardiac fibroblasts (CFs) were transfected with miR-146a. RT-PCR and western blot were used to detect the expression of downstream effectors to further verify the function of miRNA-146a in regulating MF via the TLR-4 signaling pathway. Results miR-146a was increased in the CP-8W group but not in the CP-16W group. IRAK1 and TRAF6 in the CP-16W group were found to be higher than in the N group and CP-8W group. α-SMA in the model groups was higher than in the N group. Compared with the CP-8W group, α-SMA in the CP-16W model group was further increased. In the experiments using CFs, the expression of IRAK1, TRAF6, p-NF-κB and α-SMA increased in the LPS-treated group compared with the N group. After transfection of CFs with the miR-146a mimics, the expression of IRAK1, TRAF6, p-NF-κB and α-SMA decreased compared with the LPS-treated group. Following transfection of CFs with miR-146a inhibitors, the expression of IRAK1, TRAF6, p-NF-κB and α-SMA increased compared with the LPS-treated group. Conclusions The expression of miR-146a demonstrated a dynamic change in the CP model; it was increased at the early time point (CP-8W) and then decreased at the 16W time point. miR-146a suppressed MF by inhibiting the target genes TRAF6 and IRAK1 via the TLR-4 signaling pathway.
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Affiliation(s)
- Yangjie Xiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wei Qiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xin Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lijuan Sun
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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Shojaeifard M, Pakbaz M, Beheshti R, Noohi Bezanjani F, Ahangar H, Gohari S, Dehghani Mohammad Abadi H, Erami S. The effect of colchicine on the echocardiographic constrictive physiology after coronary artery bypass graft surgery. Echocardiography 2020; 37:399-403. [PMID: 32175647 DOI: 10.1111/echo.14605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/28/2019] [Accepted: 01/17/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Constrictive physiology is a transitory condition that could lead to constrictive pericarditis, which is a rare complication after open-heart surgery. Anti-inflammatory drugs like colchicine are recommended for prevention of constrictive pericarditis; however, there is no evidence about the effect of colchicine on constrictive pericarditis. Thus, the aim of this study is to evaluate the preventive effect of colchicine on the incidence of echocardiographic constrictive physiology after open-heart surgery. METHODS This was a parallel randomized, double-blind trial. Patients were randomly assigned to receive 1 mg colchicine once-daily from 48 hours before and 0.5 mg twice daily for 5 days after surgery. Primary outcome was the incidence of the constrictive physiology after primary endpoint (1 week after the surgery). The secondary outcome was the primary outcome after secondary endpoint (4 weeks after surgery) plus the new cases of constrictive physiology between the primary and secondary endpoints. RESULTS Out of 160 participating patients, the primary outcome occurred in 19 patients (23%) in placebo and 11 (13%) in intervention groups. There was no significant difference between two groups (P = .106). After 4 weeks of follow-up, 19 patients (23%) in placebo and 9 (11%) in intervention groups had constrictive physiology whereas 2 out of 11 patients (18.2%) were recovered. The difference was significant (P = .038). No new case of constrictive physiology occurred between primary and secondary endpoints. CONCLUSION Short-term use of colchicine has a preventive effect on reducing constrictive physiology after 1 month of open-heart surgery but not a week after that.
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Affiliation(s)
- Maryam Shojaeifard
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Marzieh Pakbaz
- Department of Cardiovascular Disease, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Beheshti
- Department of Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Freidoun Noohi Bezanjani
- Department of Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Ahangar
- Department of Cardiology, Mousavi Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Sepehr Gohari
- School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | | | - Sajad Erami
- School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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10
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Wang FF, Hsu J, Jia FW, Lin X, Miao Q, Chen W, Fang LG. Left ventricular strain is associated with acute postoperative refractory hypotension in patients with constrictive pericarditis and preserved ejection fraction. J Thorac Dis 2018; 10:4147-4155. [PMID: 30174859 DOI: 10.21037/jtd.2018.06.124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Pericardiectomy is an effective treatment for constrictive pericarditis (CP). Early postoperative complications such as refractory hypotension and congestive heart failure occur in these patients and are associated with increased morbidity and mortality. We hypothesized that left ventricular (LV) myocardial strain measured by two-dimensional speckle tracking echocardiography (2DSTE) could identify early cardiac dysfunction and relate to acute postoperative adverse events in CP patients. Methods Forty-four CP patients with preserved left ventricular ejection fraction (LVpEF, 64%±8%) and 44 age- and sex-matched controls were enrolled. Conventional 2DSTE was performed before pericardiectomy. Global and segmental peak systolic strain values were measured. The primary endpoint was a composite of postoperative refractory hypotension, congestive heart failure and cardiogenic death. Refractory hypotension was defined as hypotension requiring prolonged usage of intravenous inotropic medication (IVIM) (≥2 days). Results Postoperative refractory hypotension occurred in 26 cases, and no patients experienced congestive heart failure or cardiogenic death. Compared to controls, CP patients had decreased absolute global and segmental circumferential strain (CS), radial strain (RS), and longitudinal strain (LS) except septal LS. Patients with refractory hypotension exhibited lower epicardial CS (P=0.04). Epicardial CS was an independent risk factor correlated with postoperative adverse outcome [P=0.014, OR =1.236 (1.044-1.464)] while LVEF was not. Lower absolute value of epicardial CS was related to higher (P=0.02) and longer usage of intravenous furosemide (P=0.04) to keep negative fluid balance perioperatively. Conclusions LV strain value is markedly reduced in patients with CP and LVpEF. Lower preoperative epicardial CS value is associated with greater risk of early refractory hypotension and more aggressive fluid management.
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Affiliation(s)
- Fang-Fei Wang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jeffrey Hsu
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Fu-Wei Jia
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xue Lin
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Qi Miao
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Wei Chen
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Li-Gang Fang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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11
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Lu HT, Ramsamy G, Lee CY, Syed Hamid SRG, Kan FK, Nordin RB. A Case of Constrictive Pericarditis Associated with Melioidosis in an Immunocompetent Patient Treated by Pericardiectomy. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:314-319. [PMID: 29551765 PMCID: PMC5873330 DOI: 10.12659/ajcr.908310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient: Male, 38 Final Diagnosis: Constrictive pericarditis Symptoms: Shortness of breath Medication: — Clinical Procedure: Pericardiocentesis • pericardiectomy Specialty: Cardiology
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Affiliation(s)
- Hou Tee Lu
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia.,Department of Cardiology, Sultanah Aminah Hospital , Johor Bahru, Johor, Malaysia
| | - Gunasekaran Ramsamy
- Department of Cardiology, Sultanah Aminah Hospital, Johor Bahru, Johor, Malaysia
| | - Chuey Yan Lee
- Department of Cardiology, Sultanah Aminah Hospital, Johor Bahru, Johor, Malaysia
| | - Syed Rasul G Syed Hamid
- Department of Cardiothoracic Surgery, Sultanah Aminah Hospital, Johor Bahru, Johor, Malaysia
| | - Foong Kee Kan
- Infectious Diseases Unit, Sultanah Aminah Hospital, Johor Bahru, Johor, Malaysia
| | - Rusli Bin Nordin
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
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12
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Mahmoud A, Bansal M, Sengupta PP. New Cardiac Imaging Algorithms to Diagnose Constrictive Pericarditis Versus Restrictive Cardiomyopathy. Curr Cardiol Rep 2018; 19:43. [PMID: 28405937 DOI: 10.1007/s11886-017-0851-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Echocardiography is the mainstay in the diagnostic evaluation of constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM), but no single echocardiographic parameter is sufficiently robust to accurately distinguish between the two conditions. The present review summarizes the recent advances in echocardiography that promise to improve its diagnostic performance for this purpose. The role of other imaging modalities such as cardiac computed tomography, magnetic resonance imaging, and invasive hemodynamic assessment in the overall diagnostic approach is also discussed briefly. RECENT FINDINGS A recent study has demonstrated improved diagnostic accuracy of echocardiography with integration of multiple conventional echocardiographic parameters in to a step-wise algorithm. Concurrently, the studies using speckle-tracking echocardiography have revealed distinct and disparate patterns of myocardial mechanical abnormalities in CP and RCM with their ability to distinguish between the two conditions. The incorporation of machine-learning algorithms into echocardiography workflow permits easy integration of the wealth of the diagnostic data available and promises to further enhance the diagnostic accuracy of echocardiography. New imaging algorithms are continuously being evolved to permit accurate distinction between CP and RCM. Further research is needed to validate the accuracy of these newer algorithms and to define their place in the overall diagnostic approach for this purpose.
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Affiliation(s)
- Ahmad Mahmoud
- Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt
| | - Manish Bansal
- Heart Institute - Division of Cardiology, Medanta- The Medicity, Gurgaon, India
| | - Partho P Sengupta
- Heart and Vascular Institute, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506, USA.
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13
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Role of Echocardiography in Diagnosis of Constrictive Pericarditis: a Practical Summary. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9439-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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15
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Sengupta PP, Huang YM, Bansal M, Ashrafi A, Fisher M, Shameer K, Gall W, Dudley JT. Cognitive Machine-Learning Algorithm for Cardiac Imaging: A Pilot Study for Differentiating Constrictive Pericarditis From Restrictive Cardiomyopathy. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.115.004330. [PMID: 27266599 DOI: 10.1161/circimaging.115.004330] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 04/27/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Associating a patient's profile with the memories of prototypical patients built through previous repeat clinical experience is a key process in clinical judgment. We hypothesized that a similar process using a cognitive computing tool would be well suited for learning and recalling multidimensional attributes of speckle tracking echocardiography data sets derived from patients with known constrictive pericarditis and restrictive cardiomyopathy. METHODS AND RESULTS Clinical and echocardiographic data of 50 patients with constrictive pericarditis and 44 with restrictive cardiomyopathy were used for developing an associative memory classifier-based machine-learning algorithm. The speckle tracking echocardiography data were normalized in reference to 47 controls with no structural heart disease, and the diagnostic area under the receiver operating characteristic curve of the associative memory classifier was evaluated for differentiating constrictive pericarditis from restrictive cardiomyopathy. Using only speckle tracking echocardiography variables, associative memory classifier achieved a diagnostic area under the curve of 89.2%, which improved to 96.2% with addition of 4 echocardiographic variables. In comparison, the area under the curve of early diastolic mitral annular velocity and left ventricular longitudinal strain were 82.1% and 63.7%, respectively. Furthermore, the associative memory classifier demonstrated greater accuracy and shorter learning curves than other machine-learning approaches, with accuracy asymptotically approaching 90% after a training fraction of 0.3 and remaining flat at higher training fractions. CONCLUSIONS This study demonstrates feasibility of a cognitive machine-learning approach for learning and recalling patterns observed during echocardiographic evaluations. Incorporation of machine-learning algorithms in cardiac imaging may aid standardized assessments and support the quality of interpretations, particularly for novice readers with limited experience.
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Affiliation(s)
- Partho P Sengupta
- From the Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY (P.P.S., M.B.); Saffron Technology, Inc, Cary, NC (Y.-M.H., A.A., M.F., W.G.); and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY (K.S., J.T.D.).
| | - Yen-Min Huang
- From the Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY (P.P.S., M.B.); Saffron Technology, Inc, Cary, NC (Y.-M.H., A.A., M.F., W.G.); and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY (K.S., J.T.D.)
| | - Manish Bansal
- From the Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY (P.P.S., M.B.); Saffron Technology, Inc, Cary, NC (Y.-M.H., A.A., M.F., W.G.); and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY (K.S., J.T.D.)
| | - Ali Ashrafi
- From the Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY (P.P.S., M.B.); Saffron Technology, Inc, Cary, NC (Y.-M.H., A.A., M.F., W.G.); and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY (K.S., J.T.D.)
| | - Matt Fisher
- From the Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY (P.P.S., M.B.); Saffron Technology, Inc, Cary, NC (Y.-M.H., A.A., M.F., W.G.); and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY (K.S., J.T.D.)
| | - Khader Shameer
- From the Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY (P.P.S., M.B.); Saffron Technology, Inc, Cary, NC (Y.-M.H., A.A., M.F., W.G.); and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY (K.S., J.T.D.)
| | - Walt Gall
- From the Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY (P.P.S., M.B.); Saffron Technology, Inc, Cary, NC (Y.-M.H., A.A., M.F., W.G.); and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY (K.S., J.T.D.)
| | - Joel T Dudley
- From the Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY (P.P.S., M.B.); Saffron Technology, Inc, Cary, NC (Y.-M.H., A.A., M.F., W.G.); and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY (K.S., J.T.D.)
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Liebenberg JJ, Dold CJ, Olivier LR. A prospective investigation into the effect of colchicine on tuberculous pericarditis. Cardiovasc J Afr 2017; 27:350-355. [PMID: 27965998 PMCID: PMC5412665 DOI: 10.5830/cvja-2016-035] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/16/2016] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Tuberculous (TB) pericarditis carries significant mortality and morbidity rates, not only during the primary infection, but also as part of the granulomatous scar-forming fibrocalcific constrictive pericarditis so commonly associated with this disease. Numerous therapies have previously been investigated as adjuvant strategies in the prevention of pericardial constriction. Colchicine is well described in the treatment of various aetiologies of pericarditis. The aim of this research was to investigate the merit for the use of colchicine in the management of tuberculous pericarditis, specifically to prevent constrictive pericarditis. METHODS This pilot study was designed as a prospective, double-blinded, randomised, control cohort study and was conducted at a secondary level hospital in the Northern Cape of South Africa between August 2013 and December 2015. Patients with a probable or definite diagnosis of TB pericarditis were included (n = 33). Study participants with pericardial effusions amenable to pericardiocentesis underwent aspiration until dryness. All patients were treated with standard TB treatment and corticosteroids in accordance with the South African Tuberculosis Treatment Guidelines. Patients were randomised to an intervention and control group using a web-based computer system that ensured assignment concealment. The intervention group received colchicine 1.0 mg per day for six weeks and the control group received a placebo for the same period. Patients were followed up with serial echocardiography for 16 weeks. The primary outcome assessed was the development of pericardial constriction. Upon completion of the research period, the blinding was unveiled and data were presented for statistical analysis. RESULTS TB pericarditis was found exclusively in HIV-positive individuals. The incidence of pericardial constriction in our cohort was 23.8%. No demonstrable benefit with the use of colchicine was found in terms of prevention of pericardial constriction (p = 0.88, relative risk 1.07, 95% CI: 0.46-2.46). Interestingly, pericardiocentesis appeared to decrease the incidence of pericardial constriction. CONCLUSION Based on this research, the use of colchicine in TB pericarditis cannot be advised. Adjuvant therapy in the prevention of pericardial constriction is still being investigated and routine pericardiocentesis may prove to be beneficial in this regard.
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MESH Headings
- Adrenal Cortex Hormones/therapeutic use
- Adult
- Anti-Inflammatory Agents/therapeutic use
- Antitubercular Agents/therapeutic use
- Coinfection
- Colchicine/therapeutic use
- Double-Blind Method
- Echocardiography, Doppler, Color
- Echocardiography, Doppler, Pulsed
- Female
- HIV Infections/diagnosis
- HIV Infections/epidemiology
- Humans
- Incidence
- Male
- Pericardial Effusion/microbiology
- Pericardial Effusion/therapy
- Pericardiocentesis
- Pericarditis, Constrictive/diagnostic imaging
- Pericarditis, Constrictive/epidemiology
- Pericarditis, Constrictive/microbiology
- Pericarditis, Constrictive/prevention & control
- Pericarditis, Tuberculous/diagnostic imaging
- Pericarditis, Tuberculous/drug therapy
- Pericarditis, Tuberculous/epidemiology
- Pericarditis, Tuberculous/microbiology
- Pilot Projects
- Prospective Studies
- Risk Factors
- South Africa/epidemiology
- Time Factors
- Treatment Outcome
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17
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van der Bijl P, Herbst P, Doubell AF. Redefining Effusive-Constrictive Pericarditis with Echocardiography. J Cardiovasc Ultrasound 2016; 24:317-323. [PMID: 28090260 PMCID: PMC5234338 DOI: 10.4250/jcu.2016.24.4.317] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 10/04/2016] [Accepted: 11/30/2016] [Indexed: 11/30/2022] Open
Abstract
Background Effusive-constrictive pericarditis (ECP) is traditionally diagnosed by using the expensive and invasive technique of direct pressure measurements in the pericardial space and the right atrium. The aim of this study was to assess the diagnostic role of echocardiography in tuberculous ECP. Methods Intrapericardial and right atrial pressures were measured pre- and post-pericardiocentesis, and right ventricular and left ventricular pressures were measured post-pericardiocentesis in patients with tuberculous pericardial effusions. Echocardiography was performed post-pericardiocentesis. Traditional, pressure-based diagnostic criteria were compared with post-pericardiocentesis systolic discordance and echocardiographic evidence of constriction. Results Thirty-two patients with tuberculous pericardial disease were included. Sixteen had ventricular discordance (invasively measured), 16 had ECP as measured by intrapericardial and right atrial invasive pressure measurements and 17 had ECP determined echocardiographically. The sensitivity and specificity of pressure-guided measurements (compared with discordance) for the diagnosis of ECP were both 56%. The positive and negative predictive values were both 56%. The sensitivity of echocardiography (compared with discordance) for the diagnosis of ECP was 81% and the specificity 75%, while the positive and the negative predictive values were 76% and 80%, respectively. Conclusion Echocardiography shows a better diagnostic performance than invasive, pressure-based measurements for the diagnosis of ECP when both these techniques are compared with the gold standard of invasively measured systolic discordance.
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Affiliation(s)
- Pieter van der Bijl
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Parow, South Africa
| | - Philip Herbst
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Parow, South Africa
| | - Anton F Doubell
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Parow, South Africa
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18
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Kudaiberdiev T, Joshibayev S, Imanalieva G, Beishenaliev AS, Ashinaliev AA, Baisekeev TA, Chinaliev S. Predictors of tamponade and constriction in patients with pericardial disease undergoing interventional and surgical treatment. IJC HEART & VASCULATURE 2016; 12:75-81. [PMID: 28616547 PMCID: PMC5454173 DOI: 10.1016/j.ijcha.2016.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/23/2016] [Accepted: 07/28/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of our study was to define predictors of cardiac compression development including clinical, electrocardiographic, echocardiographic, chest-X-ray and perioperative parameters and their diagnostic value. METHODS Overall 243 patients with pericardial disease, among them 123 with compression (tamponade, constriction) and 120 without signs of compression were included in the study. Clinical, laboratory, electrocardiographic, chest-X-Ray, echocardiographic and perioperative data were included in the logistic regression analysis to define predictors of tamponade/constriction development. RESULTS Logistic regression analysis demonstrated large effusion (> 20 mm) (OR 5.393, 95%CI 1.202-24.199, p = 0.028), cardiac chamber collapse (OR 31.426, 95%CI 1.609-613-914, p = 0.023) and NYHA class > 3 (OR 8.671, 95%CI 1.730-43.451, p = 0.009) were multivariable predictors of compression development. The model including these three variables allowed predicting compression in 91.7% of cases. ROC analyses demonstrated that all three variables had significant diagnostic value with sensitivity of 75.6% and specificity of 74.2% for large effusion, low sensitivity and high specificity for cardiac chamber collapse (35% and 92%) and NYHA class (32.5% and 94.2%). CONCLUSION The independent predictors of compression development are presence of large effusion > 20 mm, cardiac chamber collapse and high NYHA class. The model including all three parameters allows correctly predicting compression in 91.4% of cases. The diagnostic accuracy of each parameter is characterized by high sensitivity and specificity of large effusion, high specificity of cardiac chamber collapse and NYHA class.
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Affiliation(s)
- Taalaibek Kudaiberdiev
- Scientific Research Institute of Heart Surgery and Organ Transplantation, Bishkek, Kyrgyzstan
- Department of General Surgery, Faculty of Medicine, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
| | | | - Gulzada Imanalieva
- Scientific Research Institute of Heart Surgery and Organ Transplantation, Bishkek, Kyrgyzstan
| | - Alimkadir S. Beishenaliev
- Department of General Surgery, Faculty of Medicine, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
| | - Abdulin A. Ashinaliev
- Department of General Surgery, Faculty of Medicine, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
| | - Taalaibek A. Baisekeev
- Department of General Surgery, Faculty of Medicine, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
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19
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Madeira M, Teixeira R, Costa M, Gonçalves L, Klein AL. Two-dimensional speckle tracking cardiac mechanics and constrictive pericarditis: systematic review. Echocardiography 2016; 33:1589-1599. [DOI: 10.1111/echo.13293] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Marta Madeira
- Serviço de Cardiologia; Centro Hospitalar e Universitário de Coimbra - Hospital Geral; Coimbra Portugal
| | - Rogério Teixeira
- Serviço de Cardiologia; Centro Hospitalar e Universitário de Coimbra - Hospital Geral; Coimbra Portugal
- Faculty of Medicine, University of Coimbra; Coimbra Portugal
| | - Marco Costa
- Serviço de Cardiologia; Centro Hospitalar e Universitário de Coimbra - Hospital Geral; Coimbra Portugal
| | - Lino Gonçalves
- Serviço de Cardiologia; Centro Hospitalar e Universitário de Coimbra - Hospital Geral; Coimbra Portugal
- Faculty of Medicine, University of Coimbra; Coimbra Portugal
| | - Allan L. Klein
- Heart and Vascular Institute; Center for the Diagnosis and Treatment of Pericardial Diseases; Cleveland Clinic; Cleveland OH USA
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20
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Electrocardiographic abnormalities in patients with pericardial disease — Association of PR segment depression with arrhythmias and clinical signs: Experience of cardiac surgery center. J Electrocardiol 2016; 49:29-36. [DOI: 10.1016/j.jelectrocard.2015.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Indexed: 12/31/2022]
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21
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Cho IJ, Chang HJ, Chung H, Lee SE, Shim CY, Hong GR, Ha JW, Chung N. Differential Impact of Constrictive Physiology after Pericardiocentesis in Malignancy Patients with Pericardial Effusion. PLoS One 2015; 10:e0145461. [PMID: 26691279 PMCID: PMC4686385 DOI: 10.1371/journal.pone.0145461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 12/03/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Echocardiographic signs of constrictive physiology (CP) after pericardiocentesis are frequently observed in malignancy patients. The purpose of the current study was to explore whether features of CP after pericardiocentesis have prognostic impact in malignancy patients with pericardial effusion (PE). METHODS We retrospectively reviewed 467 consecutive patients who underwent pericardiocentesis at our institution from January 2006 to May 2014. Among them, 205 patients with advanced malignancy who underwent comprehensive echocardiography after the procedure comprised the study population. Co-primary end points were all-cause mortality (ACM) and repeated drainage (RD) for PE. Patients were divided into four subgroups according to cytologic result for malignant cells and CP (positive cytology with negative CP, both positive, both negative, and negative cytology with positive CP). RESULTS CP after pericardiocentesis was present in 106 patients (50%) at median 4 days after the procedure. During median follow-up of 208 days, ACM and RD occurred in 162 patients (79%) and 29 patients (14%), respectively. Cox regression analysis revealed that independent predictors for ACM were male gender and positive cytology (all, p < 0.05). For RD, predictors were positive cytology, the absence of cardiac tamponade, and negative CP after pericardiocentesis (all, p < 0.05). When the patients were divided into four subgroups, patients with negative cytology and positive CP demonstrated the most favorable survival (hazard ratio [HR]: 0.39, p = 0.005) and the lowest RD rates (HR: 0.07, p = 0.012). CONCLUSION CP after pericardiocentesis is common, but does not always imply poor survival or the need for RD in patients with advanced malignancies. On the contrary, the presence of CP in patients with negative cytology conferred the most favorable survival and the lowest rate of RD. Comprehensive echocardiographic evaluation for CP after pericardiocentesis would be helpful for predicting prognosis in patients with advanced malignancies.
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Affiliation(s)
- In-Jeong Cho
- Department of Internal Medicine, Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyuk-Jae Chang
- Department of Internal Medicine, Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Hyemoon Chung
- Department of Internal Medicine, Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang-Eun Lee
- Department of Internal Medicine, Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chi Young Shim
- Department of Internal Medicine, Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Geu-Ru Hong
- Department of Internal Medicine, Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong-Won Ha
- Department of Internal Medicine, Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Namsik Chung
- Department of Internal Medicine, Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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22
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Revisiting annulus paradoxus in constrictive pericarditis. Int J Cardiol 2015; 195:288-9. [DOI: 10.1016/j.ijcard.2015.05.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 05/27/2015] [Indexed: 11/23/2022]
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23
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Choudhry MW, Homsi M, Mastouri R, Feigenbaum H, Sawada SG. Prevalence and Prognostic Value of Right Ventricular Systolic Dysfunction in Patients With Constrictive Pericarditis Who Underwent Pericardiectomy. Am J Cardiol 2015; 116:469-73. [PMID: 26048852 DOI: 10.1016/j.amjcard.2015.04.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/14/2015] [Accepted: 04/14/2015] [Indexed: 11/29/2022]
Abstract
Impaired right ventricular systolic function (RVSF) may complicate the treatment of constrictive pericarditis (CP) by pericardiectomy, which is a procedure that remains with significant morbidity and mortality. We evaluated RVSF in patients with CP who underwent pericardiectomy to determine the prognostic value of RVSF. RVSF was assessed by measuring Tricuspid Annular Plane Systolic Excursion (TAPSE) in 35 patients (mean age 52 ± 15.4 years) who underwent pericardiectomy. Thirty-one patients (88.6%) had reduced RVSF (TAPSE ≤1.8 cm). Eight patients (23%) had postoperative events (heart failure 3 and hospital mortality 5). Logistic regression showed that concomitant coronary artery bypass grafting (CABG) (p = 0.052), left ventricular ejection fraction (p = 0.059), left atrial diameter (p = 0.028), and TAPSE (p = 0.016) were borderline or significant univariate predictors of events. TAPSE (p = 0.018, odds ratio = 0.605 [0.40 to 0.92]) and CABG (p = 0.033, odds ratio = 20 [1.26 to 315]) were independent predictors of events on multivariate analysis. Stepwise analysis showed that TAPSE provided incremental prognostic value (p = 0.029, chi-square increase 11.6 to 16.3) to the combination of CABG, ejection fraction, and left atrial diameter. Receiver-operating characteristic curve analysis showed an area under the curve of 0.815 for TAPSE. TAPSE of 1.38 cm had a sensitivity of 88% and specificity of 67% for identifying patients with events. TAPSE was also inversely related to the length of hospital stay after pericardiectomy (p = 0.02, R = -0.424). Hence, our study showed that RVSF is frequently reduced in patients with CP who underwent pericardiectomy. In conclusion, TAPSE is an independent predictor of events and provides incremental prognostic value to other clinical and echocardiographic variables.
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Affiliation(s)
- Muhammad W Choudhry
- The Krannert Institute of Cardiology, Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana
| | - Mohamed Homsi
- The Krannert Institute of Cardiology, Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana
| | - Ronald Mastouri
- The Krannert Institute of Cardiology, Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana
| | - Harvey Feigenbaum
- The Krannert Institute of Cardiology, Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana
| | - Stephen G Sawada
- The Krannert Institute of Cardiology, Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana.
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24
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Negishi K, Popović ZB, Negishi T, Motoki H, Alraies MC, Chirakarnjanakorn S, Dahiya A, Klein AL. Pericardiectomy is Associated with Improvement in Longitudinal Displacement of Left Ventricular Free Wall Due to Increased Counterclockwise Septal-to-Lateral Rotational Displacement. J Am Soc Echocardiogr 2015; 28:1204-1213, e2. [PMID: 26141982 DOI: 10.1016/j.echo.2015.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pericardiectomy is an effective intervention for constrictive pericarditis. Speckle-tracking echocardiography can provide quantitative information not only about longitudinal strain (LS) but about longitudinal displacement (LD) and septal-to-lateral rotational displacement (SLRD). The aim of this study was to investigate whether pericardiectomy improves myocardial mechanics using speckle-tracking analysis. METHODS Eighty-three patients with constrictive pericarditis who underwent echocardiography were retrospectively assessed (mean age, 58 ± 12 years; 72 men; 50 idiopathic, 20 postoperative, four viral, three radiation, and six others) and compared with 20 healthy volunteers. LD and SLRD were measured from the apical four-chamber view and global LS from three apical views. RESULTS LD was less in the constrictive pericarditis group compared with control subjects (P < .001). Only lateral LS was significantly less than that of control subjects (P < .001), but septal LS was similar (P = .48). In pre- and post-pericardial surgery comparisons (n = 27), values of septal and lateral LD were almost identical (mean, 13.6 ± 4.7 vs 13.3 ± 5.4 mm; P = .70) before pericardiectomy, but septal LD decreased (mean, 9.3 ± 3.5 mm; P < .001) and lateral LD increased (mean, 16.8 ± 4.7 mm; P = .0106) after the surgery, even though the difference in LS between the septal and lateral walls decreased (from 5.6 ± 5.3% to 2.5 ± 4.2%, P = .008). Systolic whole-heart swinging motion significantly increased to a counterclockwise direction after surgery (mean SLRD, -0.8 ± 3.3° vs 2.1 ± 3.0°; P = .001). Although the change in SLRD after pericardiectomy was not different between patients with decreases and increases in New York Heart Association class, SLRD change was significantly greater in patients who received fewer diuretics after surgery (mean, 4.00 ± 0.91 vs 0.27 ± 1.47; P = .027). CONCLUSIONS After surgical removal of the pericardium, LD of the septal and lateral walls became significantly different, and counterclockwise SLRD increased, reflecting loss of pericardial support.
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Affiliation(s)
- Kazuaki Negishi
- Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Zoran B Popović
- Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Tomoko Negishi
- Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Hirohiko Motoki
- Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio
| | - M Chadi Alraies
- Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Srisakul Chirakarnjanakorn
- Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Arun Dahiya
- Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Allan L Klein
- Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, Ohio.
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Constrictive Pericarditis in the Presence of Remaining Remnants of a Left Ventricular Assist Device in a Heart Transplanted Patient. Case Rep Transplant 2015; 2015:372698. [PMID: 26090261 PMCID: PMC4454733 DOI: 10.1155/2015/372698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 05/03/2015] [Accepted: 05/11/2015] [Indexed: 11/17/2022] Open
Abstract
Constrictive pericarditis (CP) is a severe subform of pericarditis with various causes and clinical findings. Here, we present the unique case of CP in the presence of remaining remnants of a left ventricular assist device (LVAD) in a heart transplanted patient. A 63-year-old man presented at the Heidelberg Heart Center outpatient clinic with progressive dyspnea, fatigue, and loss of physical capacity. Heart transplantation (HTX) was performed at another heart center four years ago and postoperative clinical course was unremarkable so far. Pharmacological cardiac magnetic resonance imaging (MRI) stress test was performed to exclude coronary ischemia. The test was negative but, accidentally, a foreign body located in the epicardial adipose tissue was found. The foreign body was identified as the inflow pump connection of an LVAD which was left behind after HTX. Echocardiography and cardiac catheterization confirmed the diagnosis of CP. Surgical removal was performed and the epicardial tubular structure with a diameter of 30 mm was carefully removed accompanied by pericardiectomy. No postoperative complications occurred and the patient recovered uneventfully with a rapid improvement of symptoms. On follow-up 3 and 6 months later, the patient reported about a stable clinical course with improved physical capacity and absence of dyspnea.
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Stephens G, Bhagwat K, Marasco S, McGiffin D. Constrictive pericarditis post-lung transplant. J Card Surg 2015; 30:651-5. [PMID: 26058901 DOI: 10.1111/jocs.12581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Constrictive pericarditis is a rare entity following lung transplant, with only seven previous cases reported in the literature. We present two additional cases and review the literature on this subject. Constrictive pericarditis should be considered in lung transplant patients who present with dyspnea and evidence of cardiac failure. Pericardiectomy remains the treatment of choice irrespective of the etiology.
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Affiliation(s)
- Georgina Stephens
- Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne, VIC, Australia
| | - Krishna Bhagwat
- Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne, VIC, Australia
| | - Silvana Marasco
- Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne, VIC, Australia.,Monash University, Melbourne, VIC, Australia
| | - David McGiffin
- Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne, VIC, Australia.,Monash University, Melbourne, VIC, Australia
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Fadel BM, Alkalbani A, Husain A, Dahdouh Z, Di Salvo G. Respiratory hemodynamics in the hepatic veins--abnormal patterns. Echocardiography 2014; 32:705-10. [PMID: 25252115 DOI: 10.1111/echo.12757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The flow pattern in the hepatic veins (HVs) is dependent on the cardiac cycle and right heart hemodynamics and influenced by the respiratory cycle and the liver parenchyma. Most disease states that affect the right heart alter the HV Doppler in a manner independent of the respiratory cycle. Some diseases that typically involve the pericardium, right ventricular myocardium, or respiratory system confer characteristic changes to the HV flow in a manner dependent on the respiratory cycle. Analysis of the HV Doppler with assessment of the respiratory changes in flow and their timing helps to distinguish among the various disease states. In this manuscript, we discuss the effect of respiration on HV flow in patients with abnormal right heart function and illustrate the use of the respiratory changes in the HV Doppler as a tool for diagnosis.
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Affiliation(s)
- Bahaa M Fadel
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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Quantitative and pattern analyses of continuous-wave Doppler-derived pulmonary regurgitant flow velocity for the diagnosis of constrictive pericarditis. J Am Soc Echocardiogr 2014; 27:1223-9. [PMID: 25096415 DOI: 10.1016/j.echo.2014.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Many echocardiographic features of constrictive pericarditis (CP) have been reported, but each alone has a limitation either in sensitivity or in specificity. Continuous-wave Doppler-derived flow velocity of pulmonary regurgitation can reflect the diastolic right ventricular pressure pattern characteristic of CP and be useful for its detection. METHODS Fifteen patients with CP, 18 patients with restrictive cardiomyopathy, and 20 normal subjects were studied retrospectively. Using continuous-wave Doppler echocardiography, pulmonary regurgitation velocities were measured at the early diastolic peak (VMAx), mid-diastolic inflection point (VIFL), and late diastolic minimal point (VMIN). RESULTS VIFL, VIFL/VMAx, VMIN, and VMIN/VMAx were significantly lower in the CP group compared with the restrictive cardiomyopathy and normal groups. Prevalence rates of patients with early mid-diastolic inflection, VIFL/VMAx < 0.5, VMIN < 50 cm/sec, and VMIN/VMAx < 0.33 were significantly greater in the CP group compared with the other groups. Sensitivity and specificity for the diagnosis of CP were 93% and 74%, respectively, for the presence of early mid-diastolic inflection, 73% and 100% for VIFL/VMAx < 0.5, 73% and 97% for VMIN < 50 cm/sec, and 93% and 92% for VMIN/VMAx < 0.33. CONCLUSIONS The quantitative and pattern analyses of continuous-wave Doppler-derived pulmonary regurgitation velocity could enhance the accuracy of echocardiographic detection of CP.
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Prognostic predictors in pericardiectomy for chronic constrictive pericarditis. J Thorac Cardiovasc Surg 2014; 147:598-605. [DOI: 10.1016/j.jtcvs.2013.01.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 11/15/2012] [Accepted: 01/11/2013] [Indexed: 11/20/2022]
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Yingchoncharoen T, Alraies MC, Kwon DH, Rodriguez ER, Tan CD, Klein AL. Emerging role of multimodality imaging in management of inflammatory pericardial diseases. Expert Rev Cardiovasc Ther 2014; 11:1211-25. [DOI: 10.1586/14779072.2013.832624] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Brunner NW, Ramachandran K, Kudelko KT, Sung YK, Spiekerkoetter E, Yang PC, Zamanian RT, Perez VDJ. A case of recurrent pericardial constriction presenting with severe pulmonary hypertension. Pulm Circ 2013; 3:436-9. [PMID: 24015347 PMCID: PMC3757841 DOI: 10.4103/2045-8932.114780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chronic constrictive pericarditis (CP) is a relatively rare condition in which the pericardium becomes fibrotic and noncompliant, eventually resulting in heart failure due to impaired ventricular filling. The only curative treatment is pericardiectomy. Classically, CP does not usually cause severe pulmonary hypertension. When attempting to differentiate CP from restrictive cardiomyopathy, the presence of severely elevated pulmonary arterial pressure is used as a diagnostic criterion ruling against CP. We present a case of proven recurrent pericardial constriction following pericardiectomy presenting with severe pulmonary hypertension.
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Affiliation(s)
- Nathan W Brunner
- Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, California, USA ; Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Stanford, California, USA
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Motoki H, Alraies MC, Dahiya A, Saraiva RM, Hanna M, Marwick TH, Klein AL. Changes in left atrial mechanics following pericardiectomy for pericardial constriction. J Am Soc Echocardiogr 2013; 26:640-8. [PMID: 23562086 DOI: 10.1016/j.echo.2013.02.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although impaired left ventricular (LV) filling in constrictive pericarditis (CP) is attributable to external constraints by a tethered pericardium, impaired left atrial (LA) function can further impair LV filling. Previous studies focused on the impact of a tethered pericardium on LV diastolic behavior, but its impact on LA function has been largely overlooked. The objectives of this study were to evaluate LA mechanics in CP and to assess the impact of pericardiectomy on LA mechanics. METHODS A total of 52 patients with CP (mean age, 57 ± 12 years) and 19 control subjects were studied retrospectively. All patients with CP underwent echocardiography before (median, 12 days; interquartile range, 5-34 days) and after pericardiectomy (median, 20 days; interquartile range, 5-64 days). Global LA longitudinal strain (ε) was calculated, which included peak negative ε (εnegative), peak positive ε (εpositive), and the sum of those values, total LA ε (εtotal), using speckle-tracking echocardiography with Velocity Vector Imaging. The regional difference of LA ε between the septal and lateral walls was assessed before and after the procedure. RESULTS Patients with CP showed depressed global LA εnegative, LA εtotal, and LA εpositive compared with controls. LA contractile (global LA εnegative) and reservoir functions (global LA εtotal) showed significant increases after pericardiectomy. Regional analysis revealed that the improvement in LA function after surgery was more apparent in lateral segments, while the regional function of septal walls was depressed after surgery. CONCLUSIONS Patients with CP have impaired LA mechanics, presumably because of the constrictive tethering process involving the left atrium. Speckle-tracking echocardiography showed consistent results of changes in LA mechanics with conventional echocardiographic parameters early after the procedure. Regional ε analysis aided in recognition of the impact of constrictive tethering and pericardiectomy on LA function.
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Affiliation(s)
- Hirohiko Motoki
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Silva D, Sargento L, Varela MG, Lopes M, Brito D, Madeira H. Constrictive pericarditis – New methods in the diagnosis of an old disease: A case report. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.repce.2012.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Silva D, Sargento L, Gato Varela M, Lopes MG, Brito D, Madeira H. [Constrictive pericarditis - new methods in the diagnosis of an old disease: a case report]. Rev Port Cardiol 2012; 31:677-82. [PMID: 22954618 DOI: 10.1016/j.repc.2012.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 01/25/2012] [Indexed: 10/27/2022] Open
Abstract
Constrictive pericarditis is a rare clinical entity that can pose diagnostic problems. The gold standard for diagnosis is cardiac catheterization with analysis of intracavitary pressure curves, which are high and, in end-diastole, equal in all chambers. The diastolic profile in both ventricles presents the classic dip-and-plateau pattern and the difference between the diastolic pressures of both ventricles should not exceed 3-5mmHg. Unfortunately, these traditional criteria are not always present and in fact the sensitivity and specificity of equalization of diastolic pressures are relatively low and of limited value in individual patients. This highlights the need to use new cardiac imaging techniques to resolve any doubts. The case described here is a good example.
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Affiliation(s)
- Doroteia Silva
- Serviço de Cardiologia I, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.
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Advances in the differentiation of constrictive pericarditis and restrictive cardiomyopathy. Herz 2012; 37:664-73. [DOI: 10.1007/s00059-012-3663-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Oreto L, Mayer A, Todaro MC, Mori N, Kress DC, Kleinman LH, Allaqaband S, Bajwa T, Paterick TE, Tajik AJ, Khandheria BK. Contemporary clinical spectrum of constrictive pericarditis: a 10-year experience. Int J Cardiol 2012; 163:339-341. [PMID: 22818238 DOI: 10.1016/j.ijcard.2012.06.083] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 06/24/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Lilia Oreto
- Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy
| | - Alexander Mayer
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, USA
| | - Maria Chiara Todaro
- Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy
| | - Naoyo Mori
- Center for Urban Population Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - David C Kress
- Aurora Medical Group, Cardiovascular and Thoracic Surgery, Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | - Leonard H Kleinman
- Aurora Medical Group, Cardiovascular and Thoracic Surgery, Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | - Suhail Allaqaband
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, USA
| | - Tanvir Bajwa
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, USA
| | - Timothy E Paterick
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, USA
| | - A Jamil Tajik
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, USA
| | - Bijoy K Khandheria
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, USA.
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Oxborough D, George K, Birch KM. Intraobserver Reliability of Two-Dimensional Ultrasound Derived Strain Imaging in the Assessment of the Left Ventricle, Right Ventricle, and Left Atrium of Healthy Human Hearts. Echocardiography 2012; 29:793-802. [DOI: 10.1111/j.1540-8175.2012.01698.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
PURPOSE OF REVIEW When present clinically, cardiac involvement in systemic sclerosis (SSc) is a major risk factor for death. It is therefore vitally important to understand the epidemiology, screening, diagnosis, and treatment of the cardiac manifestations of SSc. RECENT FINDINGS The epidemiology of cardiac involvement in SSc has been the subject of several recent studies. Most importantly, the prevalence of overt left ventricular (LV) systolic dysfunction and its associated risk factors have been defined, and patients with diffuse cutaneous SSc appear to be most susceptible to direct cardiac involvement. From a diagnostic and screening standpoint, tissue Doppler echocardiography and natriuretic peptides have provided fresh insight into subclinical cardiac dysfunction in SSc. Newer techniques, such as speckle-tracking echocardiography, diffuse myocardial fibrosis imaging, and absolute myocardial perfusion imaging, are poised to further advance our knowledge. Lastly, there is now consistent observational data to suggest a central role for calcium channel blockers in the treatment of microvascular ischemia and prevention of overt LV systolic dysfunction, although randomized controlled trials are lacking. SUMMARY Recent studies have improved our understanding of cardiac involvement in SSc. Nevertheless, key questions regarding screening, diagnosis, and treatment remain. Novel diagnostic techniques and multicenter studies should yield important new data, which will hopefully ultimately result in improved outcomes.
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Anesthesia and the patient with pericardial disease. Can J Anaesth 2011; 58:952-66. [PMID: 21789738 DOI: 10.1007/s12630-011-9557-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 06/29/2011] [Indexed: 01/30/2023] Open
Abstract
PURPOSE Pericardial diseases present unique perioperative considerations for the anesthesiologist. The purpose of this review is to provide a summary of the pertinent issues related to the etiology, diagnosis, pathophysiology, and perioperative management of patients presenting for operative treatment of pericardial disease. SOURCE A selective search of the anesthesia, cardiology, and cardiothoracic surgical literature was carried out with particular emphasis on acute pericarditis, effusion, tamponade, and constrictive pericarditis. PRINCIPAL FINDINGS The anesthesiologist needs to be well versed in the etiology (i.e., differential diagnosis), pathophysiology, and diagnostic modalities in order to best prepare the patient for surgery. Diagnosis and guidance of management requires a working knowledge of the specific associated hemodynamic consequences, particularly of the impaired diastolic function that can occur. Echocardiography is essential in the diagnosis and management of these patients. CONCLUSIONS Patients with acute and chronic pericardial diseases often require the need for surgical intervention. Several unique features of acute tamponade and constrictive pericarditis require careful perioperative consideration. With proper preparation and pre-anesthetic optimization, patients with a variety of pericardial diseases can be safely managed before, during, and after their surgical intervention.
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Mookadam F, Jiamsripong P, Raslan SF, Panse PM, Tajik AJ. Constrictive pericarditis and restrictive cardiomyopathy in the modern era. Future Cardiol 2011; 7:471-83. [DOI: 10.2217/fca.11.18] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The differentiation between constrictive pericarditis and restrictive cardiomyopathy can be clinically challenging. Pericardial constriction results from scarring and consequent loss of pericardial elasticity leading to impaired ventricular filling. Restrictive cardiomyopathy is characterized by a nondilated rigid ventricle, severe diastolic dysfunction and restrictive filling producing hemodynamic changes, similar to those in constrictive pericarditis. While constrictive pericarditis is usually curable by surgical treatment, restrictive cardiomyopathy requires medical therapy and in appropriate patients, the definitive treatment is cardiac transplantation. Sufficient differences exist between the two conditions to allow noninvasive differentiation, but no single diagnostic tool can be relied upon to make this distinction. Newer echocardiographic techniques such as speckle-track imaging, velocity vector imaging, as well as cardiac computed tomography and cardiac MRI can help differentiate constriction from restriction with high sensitivity and specificity. Outcomes are better with early diagnosis of constriction in particular and early surgical resection.
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Affiliation(s)
- Farouk Mookadam
- Division of Cardiovascular Diseases, Mayo Clinic, 13400 E. Shea Blvd, Scottsdale, AZ 85259, USA
| | - Panupong Jiamsripong
- Division of Cardiovascular Diseases, Mayo Clinic, 13400 E. Shea Blvd, Scottsdale, AZ 85259, USA
| | - Serageldin F Raslan
- Division of Cardiovascular Diseases, Mayo Clinic, 13400 E. Shea Blvd, Scottsdale, AZ 85259, USA
| | | | - A Jamil Tajik
- Division of Cardiovascular Diseases, Mayo Clinic, 13400 E. Shea Blvd, Scottsdale, AZ 85259, USA
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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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Choi HO, Song JM, Shim TS, Kim SH, Jung IH, Kang DH, Song JK. Prognostic value of initial echocardiographic features in patients with tuberculous pericarditis. Korean Circ J 2010; 40:377-86. [PMID: 20830251 PMCID: PMC2933462 DOI: 10.4070/kcj.2010.40.8.377] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 03/02/2010] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Tuberculous (TB) pericarditis is a major cause of constrictive pericarditis requiring pericardiectomy. We sought to determine initial prognostic factors in patients with TB pericarditis. SUBJECTS AND METHODS We evaluated initial presentation and clinical outcomes (mean follow-up 32±27 months) in 60 consecutive patients newly diagnosed with TB pericarditis. RESULTS Initial presentations were pericardial effusion (PE), effusive-constrictive pericarditis, and constrictive pericarditis in 45 (75%), 9 (15%), and 6 (10%) patients, respectively. Of the 54 patients without initial constrictive pericarditis, 32 (59%) showed echogenic materials in PE, including frond-like exudative coating and fibrinous strands. These patients had a longer disease duration before diagnosis, were initially more symptomatic, in a more advanced state, showed more persistent pericardial constrictions (38% vs. 0%, p<0.001) despite anti-TB medications, and tended to require pericardiectomy more often (19% vs. 0%, p=0.07, p<0.05 by Kaplan-Meier). All patients with effusive-constrictive pericarditis showed echogenic PE. Of the 60 total patients, 10 (17%) underwent pericardiectomies during follow-up. All of these patients showed initial pericardial constrictions, whereas no patient without initial pericardial constriction underwent pericardiectomy (p<0.001). Seven patients showed transient pericardial constrictions that resolved without pericardiectomy. CONCLUSION Initial pericardial constriction and echogenic PE are poor prognostic signs for persistent pericardial constriction and pericardiectomy in patients with newly diagnosed TB pericarditis. These results suggest that early diagnosis and prompt anti-TB medication may be critical.
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Affiliation(s)
- Hyung Oh Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Chamsi-Pasha MAR, Anwar AM, Nosir YFM, Ajam A, Abukhudair W, Ashmeg A, Chamsi-Pasha H. Organized intrapericardial haematoma: a rare cause of heart failure after 2 years of trauma. Eur Heart J Cardiovasc Imaging 2010; 12:E1. [PMID: 20705677 DOI: 10.1093/ejechocard/jeq094] [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: 11/14/2022] Open
Abstract
Intrapericardial organized haematoma secondary to blunt chest trauma is an extremely rare cause of constrictive pericarditis. We report a 30-year-old male who presented with heart failure for 12 months and was found to have an organized intrapericardial haematoma secondary to blunt chest trauma in a road traffic accident 2 years prior. The use of multiple imaging modalities including two-dimensional (transthoracic and transoesophageal) echocardiogram and cardiac magnetic resonance imaging established the diagnosis. Surgical excision of the haematoma and removal of the constricting pericardium relieved his symptoms.
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Affiliation(s)
- Mark A. Crandall
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
| | - Sharon L. Mulvagh
- Adviser to resident and Consultant in Cardiovascular Diseases, Mayo Clinic, Rochester, MN
- Individual reprints of this article are not available. Address correspondence to Sharon L. Mulvagh, MD, Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905 ()
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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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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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Mookadam F, Jiamsripong P, Oh JK, Khandheria BK. Spectrum of pericardial disease: part I. Expert Rev Cardiovasc Ther 2009; 7:1149-57. [PMID: 19764866 DOI: 10.1586/erc.09.71] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Pericardial disease is a common disorder seen in varying clinical settings and may be the first manifestation of an underlying systemic disease. It may be due to multiple causes. Epidemiologic studies are lacking, and the exact incidence and prevalence are unknown. New diagnostic techniques have improved diagnosis, allowing early diagnosis and management. There are few randomized data to guide physicians in the management of pericardial diseases. Part I of our review focuses on the current state of knowledge and management of the more common pericardial diseases: acute pericarditis, pericardial effusion, cardiac tamponade, chronic pericarditis and relapsing pericarditis.
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Affiliation(s)
- Farouk Mookadam
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Scottsdale, AZ 85259, USA.
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Altemimi HA, Altaf SY, James RK, Nata R, Kumar EB, Codispoti M. A difficult diagnosis - constrictive pericarditis and its treatment: a case report. CASES JOURNAL 2009; 2:9105. [PMID: 20062682 PMCID: PMC2803902 DOI: 10.1186/1757-1626-2-9105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Accepted: 11/28/2009] [Indexed: 11/26/2022]
Abstract
The diagnosis of constrictive pericarditis requires a high degree of clinical suspicion, for the signs and symptoms of this disease can be falsely attributed to other causes. Herein, we present a case of a 70-year old retired farmer whose symptoms of right heart failure were initially attributed to co-existing pneumonia and pulmonary embolism. He was discharged. Three weeks later he presented with worsening breathlessness and ascites. Echocardiography, computed tomography and cardiac catheterization revealed the diagnosis of constrictive pericarditis. He underwent complete pericardectomy and to date has made a good recovery. This case exemplifies the difficulty in diagnosing this condition, the investigation required, and provides a discussion of the benefit and outcomes of prompt treatment.
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Jiamsripong P, Alharthi MS, Calleja AM, McMahon EM, Mookadam F, Khandheria BK, Belohlavek M. Quantification of left ventricular twisting mechanics by velocity vector imaging in an animal model of pericardial adhesions. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:1963-1972. [PMID: 19828233 DOI: 10.1016/j.ultrasmedbio.2009.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 05/26/2009] [Accepted: 06/04/2009] [Indexed: 05/28/2023]
Abstract
Diagnosis of constrictive pericarditis remains clinically challenging. Untwisting of the left ventricle (LV) is essential for normal LV diastolic function. Echocardiography is able to measure LV twisting mechanics. We designed an animal model of constrictive pericarditis to determine how pericardial-epicardial adhesions impair LV twisting mechanics. In eight open-chest pigs, the heart was exposed while preserving the pericardium. We simulated early constrictive pericarditis by pericardial constriction and patchy adhesions induced with instant glue and pericardial-epicardial stitches. Using Velocity Vector Imaging (VVI), LV magnitudes of twisting and untwisting were measured along with hemodynamic data at baseline and after the experimental intervention. Significant decreases in end-diastolic volume, ejection fraction, stroke volume, and late diastolic filling velocity reflected the effects of the pericardial adhesions. Magnitude of LV untwisting rate decreased from -80+/-23 degrees /s to -26+/-10 degrees /s (p=0.0009). LV twisting rate dropped from 78+/-20 degrees /s to 40+/-8 degrees /s (p=0.0039) and LV twist magnitude decreased from 9+/-2 degrees to 5+/-2 degrees (p=0.0081). Patchy pericardial adhesions are associated with reductions in LV untwisting rate and twisting magnitude, consistent with a negative impact of constrictive pericarditis on systolic and diastolic function. Impairments in LV twisting mechanics may have a diagnostic role in the detection of early stages of constrictive pericarditis.
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Affiliation(s)
- Panupong Jiamsripong
- Translational Ultrasound Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, USA
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Echocardiographic assessment of left ventricular diastolic function: what we able to do in 2009. COR ET VASA 2009. [DOI: 10.33678/cor.2009.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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