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Fakadej T, Hathaway QA, Balar AB, Amin MS, Lakhani DA, Kim C. Eosinophilic myocarditis: Case report and brief review of the literature. Radiol Case Rep 2023; 18:306-311. [PMID: 36388617 PMCID: PMC9664397 DOI: 10.1016/j.radcr.2022.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022] Open
Abstract
Eosinophilic myocarditis (EM) is a cardiac manifestation of hypereosinophilic syndrome with a high mortality rate. EM shares imaging features similar to other restrictive cardiopathies, and include patchy intramural late gadolinium enhancement on cardiac magnetic resonance with or without presence of biventricular thrombus. Diagnosis is confirmed on histopathology, and is the current gold standard. Here we report clinical presentation and imaging findings of EM in a 70-year-old woman who presented with fever and chills.
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Dhont S, Van Belleghem Y, De Zaeytijd J, Vandecasteele E. An eye-opening case report of constrictive pericarditis. Eur Heart J Case Rep 2022; 6:ytac287. [PMID: 35975098 PMCID: PMC9373953 DOI: 10.1093/ehjcr/ytac287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/21/2021] [Accepted: 07/06/2022] [Indexed: 11/25/2022]
Abstract
Background Constrictive pericarditis is characterized by the encasement of the heart by a stiff pericardium leading to impaired diastolic function, which ultimately leads to congestive heart failure. Case summary We report a case of a young woman, who first presented to the ophthalmologist with the sudden appearance of floaters and vision reduction. Eventually, invasive haemodynamic assessment led to the diagnosis of constrictive pericarditis leading to venous congestion. Conclusion Understanding the pathophysiology and integrating the results of invasive and non-invasive diagnostic work up is important in making this challenging diagnosis.
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Affiliation(s)
- Sebastiaan Dhont
- Department of Cardiology, Ghent University Hospital , Corneel Heymanslaan 10 , 9000 Ghent, Belgium
| | - Yves Van Belleghem
- Department of Cardiac Surgery, Ghent University Hospital , Ghent , Belgium
| | - Julie De Zaeytijd
- Department of Ophthalmology, Ghent University Hospital , Ghent , Belgium
| | - Els Vandecasteele
- Department of Cardiology, Ghent University Hospital , Corneel Heymanslaan 10 , 9000 Ghent, Belgium
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Zheng M, Huang H, Zhu X, Ho H, Li L, Ji X. Clinical genetic testing in four highly suspected pediatric restrictive cardiomyopathy cases. BMC Cardiovasc Disord 2022; 22:240. [PMID: 35614389 PMCID: PMC9131548 DOI: 10.1186/s12872-022-02675-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 05/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Restrictive cardiomyopathy (RCM) presents a high risk for sudden cardiac death in pediatric patients. Constrictive pericarditis (CP) exhibits a similar clinical presentation to RCM and requires differential diagnosis. While mutations of genes that encode sarcomeric and cytoskeletal proteins may lead to RCM, infection, rather than gene mutation, is the main cause of CP. Genetic testing may be helpful in the clinical diagnosis of RCM. METHODS In this case series study, we screened for TNNI3, TNNT2, and DES gene mutations that are known to be etiologically linked to RCM in four pediatric patients with suspected RCM. RESULTS We identified one novel heterozygous mutation, c.517C>T (substitution, position 517 C → T) (amino acid conversion, p.Leu173Phe), and two already known heterozygous mutations, c.508C>T (substitution, position 508, C → T) (amino acid conversion, p.Arg170Trp) and c.575G>A (substitution, position 575, G → A) (amino acid conversion, p.Arg192His), in the TNNI3 gene in three of the four patients. CONCLUSION Our findings support the notion that genetic testing may be helpful in the clinical diagnosis of RCM.
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Affiliation(s)
- Min Zheng
- Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Child Infection and Immunity, 136 Zhongshan 2nd Road, Yu Zhong District, Chongqing, 400014, China
| | - Hong Huang
- Pediatric Department, North-Kuanren General Hospital of Chongqing, Chongqing, 401121, China
| | - Xu Zhu
- Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Child Infection and Immunity, 136 Zhongshan 2nd Road, Yu Zhong District, Chongqing, 400014, China
| | - Harvey Ho
- Auckland Bioengineering Institute, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Liling Li
- Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Child Infection and Immunity, 136 Zhongshan 2nd Road, Yu Zhong District, Chongqing, 400014, China
| | - Xiaojuan Ji
- Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Child Infection and Immunity, 136 Zhongshan 2nd Road, Yu Zhong District, Chongqing, 400014, China.
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Diaz-Arocutipa C, Saucedo-Chinchay J, Imazio M, Argulian E. Natriuretic peptides to differentiate constrictive pericarditis and restrictive cardiomyopathy: A systematic review and meta-analysis. Clin Cardiol 2021; 45:251-257. [PMID: 34967020 PMCID: PMC8922532 DOI: 10.1002/clc.23772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/06/2021] [Accepted: 12/21/2021] [Indexed: 11/11/2022] Open
Abstract
Previous studies have shown that natriuretic peptide levels are increased in patients with restrictive cardiomyopathy (RCM) but not in constrictive pericarditis (CP). We performed a systematic review and meta-analysis to evaluate the diagnostic utility of B-type natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) to differentiate CP and RCM. We searched electronic databases from inception to January 07, 2021. Studies involving adult patients that assessed the utility of natriuretic peptides to differentiate CP and RCM were included. All meta-analyses were performed using a random-effects model. Seven studies (four case-control and three cohorts) involving 204 patients were included. The mean age ranged between 25.7 and 64.1 years and 77% of patients were men. BNP levels were significantly lower (standardized median difference [SMD], -1.48; 95% confidence interval [CI], -2.33 to -0.63) in patients with CP compared to RCM. The pooled area under the curve (AUC) of the BNP level was 0.81 (95% CI, 0.70-0.92). NT-proBNP (SMD, -0.86; 95% CI, -1.38 to -0.33) and log NT-proBNP (SMD, -1.89; 95% CI, -2.59 to -1.20) levels were significantly lower in patients with CP compared to RCM. Our review shows that BNP and NT-proBNP levels were significantly lower in patients with CP compared to RCM. The pooled AUC of BNP level showed a good diagnostic accuracy to differentiate both conditions.
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Affiliation(s)
- Carlos Diaz-Arocutipa
- Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru.,Programa de Atención Domiciliaria, EsSalud, Lima, Peru.,Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud (ADIECS), Lima, Peru
| | | | - Massimo Imazio
- Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Edgar Argulian
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, USA
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5
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Ditaranto R, Caponetti AG, Ferrara V, Parisi V, Minnucci M, Chiti C, Baldassarre R, Di Nicola F, Bonetti S, Hasan T, Potena L, Galiè N, Ragni L, Biagini E. Pediatric Restrictive Cardiomyopathies. Front Pediatr 2021; 9:745365. [PMID: 35145940 PMCID: PMC8822222 DOI: 10.3389/fped.2021.745365] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/28/2021] [Indexed: 12/15/2022] Open
Abstract
Restrictive cardiomyopathy (RCM) is the least frequent phenotype among pediatric heart muscle diseases, representing only 2.5-3% of all cardiomyopathies diagnosed during childhood. Pediatric RCM has a poor prognosis, high incidence of pulmonary hypertension (PH), thromboembolic events, and sudden death, is less amenable to medical or surgical treatment with high mortality rates. In this scenario, heart transplantation remains the only successful therapeutic option. Despite a shared hemodynamic profile, characterized by severe diastolic dysfunction and restrictive ventricular filling, with normal ventricle ejection fraction and wall thickness, RCM recognizes a broad etiological spectrum, consisting of genetic/familial and acquired causes, each of which has a distinct pathophysiology and natural course. Hence, the aim of this review is to cover the causes, clinical presentation, diagnostic evaluation, treatment, and prognosis of pediatric RCM.
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Affiliation(s)
- Raffaello Ditaranto
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Angelo Giuseppe Caponetti
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Valentina Ferrara
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Vanda Parisi
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Matteo Minnucci
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Chiara Chiti
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Riccardo Baldassarre
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Federico Di Nicola
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Simone Bonetti
- Pediatric Cardiac Surgery and GUCH Unit, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Tammam Hasan
- Pediatric Cardiac Surgery and GUCH Unit, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Luciano Potena
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Nazzareno Galiè
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Luca Ragni
- Pediatric Cardiac Surgery and GUCH Unit, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Elena Biagini
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
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Chiabrando JG, Bonaventura A, Vecchié A, Wohlford GF, Mauro AG, Jordan JH, Grizzard JD, Montecucco F, Berrocal DH, Brucato A, Imazio M, Abbate A. Management of Acute and Recurrent Pericarditis. J Am Coll Cardiol 2020; 75:76-92. [DOI: 10.1016/j.jacc.2019.11.021] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 12/21/2022]
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Gudiño Gomezjurado ÁF, Pujol Freitas B, Contreira Longatto F. Pericarditis constrictiva asociada a calcificación pericárdica extensa. REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Jolobe OM. Natriuretic peptide levels in constrictive pericarditis. Int J Cardiol 2019; 288:116. [DOI: 10.1016/j.ijcard.2019.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/31/2019] [Accepted: 02/07/2019] [Indexed: 10/26/2022]
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Lipshultz SE, Law YM, Asante-Korang A, Austin ED, Dipchand AI, Everitt MD, Hsu DT, Lin KY, Price JF, Wilkinson JD, Colan SD. Cardiomyopathy in Children: Classification and Diagnosis: A Scientific Statement From the American Heart Association. Circulation 2019; 140:e9-e68. [PMID: 31132865 DOI: 10.1161/cir.0000000000000682] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In this scientific statement from the American Heart Association, experts in the field of cardiomyopathy (heart muscle disease) in children address 2 issues: the most current understanding of the causes of cardiomyopathy in children and the optimal approaches to diagnosis cardiomyopathy in children. Cardiomyopathies result in some of the worst pediatric cardiology outcomes; nearly 40% of children who present with symptomatic cardiomyopathy undergo a heart transplantation or die within the first 2 years after diagnosis. The percentage of children with cardiomyopathy who underwent a heart transplantation has not declined over the past 10 years, and cardiomyopathy remains the leading cause of transplantation for children >1 year of age. Studies from the National Heart, Lung, and Blood Institute-funded Pediatric Cardiomyopathy Registry have shown that causes are established in very few children with cardiomyopathy, yet genetic causes are likely to be present in most. The incidence of pediatric cardiomyopathy is ≈1 per 100 000 children. This is comparable to the incidence of such childhood cancers as lymphoma, Wilms tumor, and neuroblastoma. However, the published research and scientific conferences focused on pediatric cardiomyopathy are sparcer than for those cancers. The aim of the statement is to focus on the diagnosis and classification of cardiomyopathy. We anticipate that this report will help shape the future research priorities in this set of diseases to achieve earlier diagnosis, improved clinical outcomes, and better quality of life for these children and their families.
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Mouyis K, Singer D, Missouris C. Grossly elevated plasma BNP does not exclude the diagnosis of constrictive pericarditis. Oxf Med Case Reports 2019; 2019:omy110. [PMID: 30697427 PMCID: PMC6345082 DOI: 10.1093/omcr/omy110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/12/2018] [Accepted: 10/17/2018] [Indexed: 11/14/2022] Open
Abstract
Pericardial effusion with constrictive physiology describes a condition in which the pericardial fluid and thickened and dense pericardium limit left ventricular (LV) diastolic filling and prevent ventricular stretch. This leads to equalization of the end-diastolic pressure in cardiac chambers and poor ventricular filling. We report two patients, who presented with symptoms and signs of severe heart failure and with significantly raised BNP levels who were subsequently diagnosed to have pericardial effusion with constrictive physiology. When VATS pericardial window procedure was performed, the BNP values transiently increased even more in both patients, and returned to pre-operative levels at 5 days post-op. We therefore propose that in contrast to current evidence, grossly elevated BNP levels can coexist with a diagnosis of constrictive pathology. Further studies into constrictive pericarditis should take into account the transient changes in BNP observed in our study that may reveal more regarding the pathophysiology of constrictive pericarditis.
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Affiliation(s)
- Kyriacos Mouyis
- Frimley Health NHS Foundation Trust, Wexham Park Hospital, Slough, UK
| | - Donald Singer
- Fellowship of Postgraduate Medicine, 11 Chandos St, London, UK
| | - Constantinos Missouris
- Frimley Health NHS Foundation Trust, Wexham Park Hospital, Slough, UK
- University of Cyprus Medical School, Nicosia, Cyprus
- Correspondence address. Frimley Health NHS Foundation Trust, Wexham Street, SL2 4HL Slough, UK. Tel: +44-207-079-4217; Fax: +44-207-580-0122; E-mail:
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