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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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2
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Charles Jain C, Egbe AC, Oh JK, Connolly HM, Miranda WR. Echo-Doppler and strain assessment of filling pressures in adults with congenitally corrected transposition and systemic right ventricles. Eur Heart J Cardiovasc Imaging 2023; 24:454-462. [PMID: 35866302 DOI: 10.1093/ehjci/jeac115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Systolic dysfunction of the systemic right ventricle (sRV) is common in adults with transposition of the great arteries and sRV. In acquired disease, diastology analysis for assessment of filling pressures (FP) is paramount in patient care. METHODS AND RESULTS Retrospective analysis of 47 adults with sRV without prior systemic tricuspid valve surgery undergoing catheterization and echocardiography within 7 days (median -2 [-1, -3]) from January 2000 to February 2021 at our institution. Median age was 48 (31, 55) years, and 16 (34.0%) patients were female. FPs were normal in 21 patients (44.7%). Left atrial size was enlarged in most patients (83.0%) with mean indexed value 58.3 ± 23.4 mL/m2. Tissue Doppler e' was not significantly different between those with high FPs vs. normal (medial 0.07 ± 0.03 vs. 0.08 ± 0.03 m/s, P = 0.63; lateral 0.08 ± 0.04 vs. 0.08 ± 0.04 m/s, P = 0.88). E velocity and subpulmonic mitral regurgitant velocity were higher in those with high FPs (0.9 ± 0.3 vs. 0.6 ± 0.2 m/s, P = 0.005; 3.8 ± 1.1 vs. 2.8 ± 0.9 m/s, P = 0.004). Left atrial reservoir strain, sRV global longitudinal strain, and subpulmonic left ventricular strain were worse in those with high FP (18.0 ± 7.6 vs. 27.9 ± 10.2%, P = 0.0009; -13.0 ± 4.4 vs. -17.9 ± 5.0%, P = 0.002; -16.8 ± 5.7 vs. -23.0 ± 3.8%, P = 0.001). CONCLUSION Despite the complex anatomy, FPs can be assessed non-invasively in adults with sRV without prior systemic tricuspid valve surgery. The current guideline algorithm for diastolic dysfunction in acquired heart disease has limited applicability in this population. Given the limitations of Doppler in this heterogeneous population, strain analysis can be a helpful adjunct for estimation of FPs.
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Affiliation(s)
- C Charles Jain
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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3
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Sohal S, Mathai SV, Lipat K, Kaur A, Visveswaran G, Cohen M, Waxman S, Tiwari N, Vucic E. Multimodality Imaging of Constrictive Pericarditis: Pathophysiology and New Concepts. Curr Cardiol Rep 2022; 24:1439-1453. [PMID: 35917048 PMCID: PMC9344806 DOI: 10.1007/s11886-022-01758-6] [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] [Accepted: 07/26/2022] [Indexed: 11/15/2022]
Abstract
Purpose of Review The unique pathophysiological changes of constrictive pericarditis (CP) can now be identified with better imaging modalities, thereby helping in its early diagnosis. Through this review, we outline the pathophysiology of CP and its translation into symptomology and various imaging findings which then are used for both diagnosis and guiding treatment options for CP. Recent Findings Multimodality imaging has provided us with the capability to recognize early stages of the disease and identify patients with a potential for reversibility and can be treated with medical management. Additionally, peri-procedural planning and prediction of post-operative complications has been made possible with the use of advanced imaging techniques. Summary Advanced imaging has the potential to play a greater role in identification of patients with reversible disease process and provide peri-procedural risk stratification, thereby improving outcomes for patients with CP.
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Affiliation(s)
- Sumit Sohal
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA.
| | - Sheetal Vasundara Mathai
- Division of Cardiovascular Diseases, Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Kevin Lipat
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Arpanjeet Kaur
- Department of Medicine, Mount Sinai West, 1000 Tenth Avenue, New York, NY, 10019, USA
| | - Gautam Visveswaran
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Marc Cohen
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Sergio Waxman
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Nidhish Tiwari
- Division of Cardiovascular Diseases, Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Esad Vucic
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
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4
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Shao Y, Yang Z, Yin L, Wang Q, Wang J. The Clinical Efficacy of Cedilanid and Isosorbide Dinitrate plus Pericardial Dissection for Chronic Constrictive Pericarditis in the Elderly and Its Influence on Plasma Endothelin, Atrial Natriuretic Peptide, and Systemic Immune-Inflammation Index. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:5406649. [PMID: 35783532 PMCID: PMC9242774 DOI: 10.1155/2022/5406649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/13/2022] [Accepted: 05/27/2022] [Indexed: 12/03/2022]
Abstract
Objective To investigate the clinical efficacy of cedilanid and isosorbide dinitrate plus pericardial dissection for chronic constrictive pericarditis in the elderly. Methods Ninety elderly patients with chronic constrictive pericarditis admitted to our hospital from March 2018 to October 2020 were recruited and assigned to receive either cedilanid and isosorbide dinitrate (control group A), pericardial dissection (control group B), or cedilanid and isosorbide dinitrate plus pericardial dissection (combination group) via random number table method, with 30 patients in each group. Outcome measures included plasma endothelin, atrial natriuretic peptide, system immune-inflammation indices, treatment effect, quality of life, mental state, and treatment satisfaction. Results The combination group had significantly higher treatment satisfaction and treatment efficacy than control groups A and B (P > 0.05). The combination group showed the lowest levels of atrial natriuretic peptide and endothelin, followed by control group A, and group B (P < 0.001). The combined therapy resulted in significantly lower levels of system immunity index, lower Hospital Anxiety and Depression Scale (HAD) scores, and better General Quality of Life Inventory-74 (GQOLI-74) scores than those of the control group B, followed by group A (P < 0.001). Conclusion Cedilanid and isosorbide dinitrate plus pericardial dissection for elderly patients with chronic constrictive pericarditis enhances the level of plasma endothelin, atrial natriuretic peptide, and systemic immune-inflammation indexes of patients and improves their quality of life, which shows great potential for clinical promotion.
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Affiliation(s)
- Yan Shao
- Department of Cardiovascular Surgery, Qinghai Provincial People's Hospital, Xining, Qinghai, China
| | - Zhirong Yang
- Department of Cardiology, Qinghai Red Cross Hospital, Xining, Qinghai, China
| | - Lu Yin
- Department of Hyperbaric Oxygen, Qinghai Provincial People's Hospital, Xining, Qinghai, China
| | - Qiang Wang
- Department of Cardiovascular Surgery, Qinghai Provincial People's Hospital, Xining, Qinghai, China
| | - Jie Wang
- Department of Anesthesiology, Qinghai Provincial People's Hospital, Xining, Qinghai, China
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5
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Smiseth OA, Morris DA, Cardim N, Cikes M, Delgado V, Donal E, Flachskampf FA, Galderisi M, Gerber BL, Gimelli A, Klein AL, Knuuti J, Lancellotti P, Mascherbauer J, Milicic D, Seferovic P, Solomon S, Edvardsen T, Popescu BA. Multimodality imaging in patients with heart failure and preserved ejection fraction: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2022; 23:e34-e61. [PMID: 34729586 DOI: 10.1093/ehjci/jeab154] [Citation(s) in RCA: 123] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/10/2021] [Indexed: 12/27/2022] Open
Abstract
Nearly half of all patients with heart failure (HF) have a normal left ventricular (LV) ejection fraction (EF) and the condition is termed heart failure with preserved ejection fraction (HFpEF). It is assumed that in these patients HF is due primarily to LV diastolic dysfunction. The prognosis in HFpEF is almost as severe as in HF with reduced EF (HFrEF). In contrast to HFrEF where drugs and devices are proven to reduce mortality, in HFpEF there has been limited therapy available with documented effects on prognosis. This may reflect that HFpEF encompasses a wide range of different pathological processes, which multimodality imaging is well placed to differentiate. Progress in developing therapies for HFpEF has been hampered by a lack of uniform diagnostic criteria. The present expert consensus document from the European Association of Cardiovascular Imaging (EACVI) provides recommendations regarding how to determine elevated LV filling pressure in the setting of suspected HFpEF and how to use multimodality imaging to determine specific aetiologies in patients with HFpEF.
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Affiliation(s)
- Otto A Smiseth
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway.,Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Daniel A Morris
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Nuno Cardim
- Cardiology Department, Hospital da Luz, Av. Lusíada, N° 100, Lisbon, Portugal
| | - Maja Cikes
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Center Zagreb, Zagreb, Croatia
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2300 RC, The Netherlands
| | - Erwan Donal
- Service de Cardiologie Et Maladies Vasculaires Et CIC-IT 1414, CHU Rennes, 35000 Rennes, France.,Université de Rennes 1, LTSI, 35000 Rennes, France
| | - Frank A Flachskampf
- Department of Medical Sciences, Clinical Physiology and Cardiology, Uppsala University Hospital, Uppsala, Sweden
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Bernhard L Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Av Hippocrate, 10/2806 Brussels, Belgium
| | - Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, Pisa 56124, Italy
| | - Allan L Klein
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Juhani Knuuti
- Turku PET Centre, University of Turku, and Turku University Hospital, Turku, Finland
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, Domaine Universitaire du Sart Tilman, Liège B4000, Belgium.,Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Julia Mascherbauer
- Department of Internal Medicine 3, Karl Landsteiner University of Health Sciences, University Hospital St. Pölten, Krems, Austria
| | - Davor Milicic
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Center Zagreb, Zagreb, Croatia
| | - Petar Seferovic
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Scott Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway.,Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, sector 2, 022328 Bucharest, Romania
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6
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Tabucanon RS, Wang TKM, Chetrit M, Furqan MM, Chan N, Pande A, Jellis CL, Cremer PC, Kwon DH, Johnston D, Klein AL. Worsened Tricuspid Regurgitation Following Pericardiectomy for Constrictive Pericarditis. Circ Cardiovasc Imaging 2021; 14:e012948. [PMID: 34607446 DOI: 10.1161/circimaging.121.012948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Worsening tricuspid regurgitation (TR) severity may occur after pericardiectomy surgery for constrictive pericarditis patients; however, its mechanisms and predictors are not well established. We evaluated the clinical characteristics, associated factors, and outcomes of worsening TR after pericardiectomy. METHODS Consecutive patients undergoing pericardiectomy for constrictive pericarditis without tricuspid valve surgery and with pre- and postoperative echocardiography available during 2000 to 2017 were retrospectively studied. Clinical, imaging, hemodynamic, and mortality characteristics were analyzed by those with and without worsening TR by at least one grade. RESULTS Among 381 patients (age 61 [17] years, 318 [83.5%] male), 193 (50.7%) had worsening TR post-operatively, and 75 died during the 2.5 (5.4) years follow-up. In univariable analysis, worsening TR was associated with a history of congestive heart failure (47.2% versus 31.9%, P=0.003), increased left atrial volume indexed (23 versus 20 mL/m2, P=0.020), reduced right ventricular fractional area change (47% versus 54%, P<0.001), and worsening mitral regurgitation (39.7% versus 16.6%, P<0.001). Worsened TR had a trend toward reduced survival during follow-up (log-rank P=0.080), especially those with worsened TR but no recovery of TR grade on subsequent echocardiography within the first year compared with those without worsened TR (log-rank P=0.02). In multivariable analysis, right ventricular fractional area change, left atrial volume indexed, left ventricular mass indexed, pulmonary artery systolic pressure, and right atrial pressure/pulmonary capillary wedge pressure ratio were most associated with worsened TR, while blood urea nitrogen, hematocrit, lateral and medial e' tissue Doppler and heart rate were most associated with mortality during follow-up. CONCLUSIONS Worsening TR severity was prevalent after pericardiectomy and had a trend toward reduced survival, especially if TR severity did not recover on subsequent echocardiography. Presence of parameters associated with worsened TR and reduced survival should alert clinicians to carefully manage these patients during follow-up.
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Affiliation(s)
- Ray S Tabucanon
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (R.S.T., T.K.M.W., M.C., M.M.F., N.C., C.L.J., P.C.C., D.H.K., A.L.K.), Cleveland Clinic, OH.,Department of Thoracic and Cardiovascular Surgery (A.P., D.J.), Cleveland Clinic, OH
| | - Tom Kai Ming Wang
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (R.S.T., T.K.M.W., M.C., M.M.F., N.C., C.L.J., P.C.C., D.H.K., A.L.K.), Cleveland Clinic, OH.,Department of Thoracic and Cardiovascular Surgery (A.P., D.J.), Cleveland Clinic, OH
| | - Michael Chetrit
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (R.S.T., T.K.M.W., M.C., M.M.F., N.C., C.L.J., P.C.C., D.H.K., A.L.K.), Cleveland Clinic, OH.,Department of Thoracic and Cardiovascular Surgery (A.P., D.J.), Cleveland Clinic, OH
| | - Muhammad M Furqan
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (R.S.T., T.K.M.W., M.C., M.M.F., N.C., C.L.J., P.C.C., D.H.K., A.L.K.), Cleveland Clinic, OH.,Department of Thoracic and Cardiovascular Surgery (A.P., D.J.), Cleveland Clinic, OH
| | - Nicholas Chan
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (R.S.T., T.K.M.W., M.C., M.M.F., N.C., C.L.J., P.C.C., D.H.K., A.L.K.), Cleveland Clinic, OH.,Department of Thoracic and Cardiovascular Surgery (A.P., D.J.), Cleveland Clinic, OH
| | - Amol Pande
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (R.S.T., T.K.M.W., M.C., M.M.F., N.C., C.L.J., P.C.C., D.H.K., A.L.K.), Cleveland Clinic, OH.,Department of Thoracic and Cardiovascular Surgery (A.P., D.J.), Cleveland Clinic, OH
| | - Christine L Jellis
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (R.S.T., T.K.M.W., M.C., M.M.F., N.C., C.L.J., P.C.C., D.H.K., A.L.K.), Cleveland Clinic, OH.,Department of Thoracic and Cardiovascular Surgery (A.P., D.J.), Cleveland Clinic, OH
| | - Paul C Cremer
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (R.S.T., T.K.M.W., M.C., M.M.F., N.C., C.L.J., P.C.C., D.H.K., A.L.K.), Cleveland Clinic, OH.,Department of Thoracic and Cardiovascular Surgery (A.P., D.J.), Cleveland Clinic, OH
| | - Deborah H Kwon
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (R.S.T., T.K.M.W., M.C., M.M.F., N.C., C.L.J., P.C.C., D.H.K., A.L.K.), Cleveland Clinic, OH.,Department of Thoracic and Cardiovascular Surgery (A.P., D.J.), Cleveland Clinic, OH
| | - Douglas Johnston
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (R.S.T., T.K.M.W., M.C., M.M.F., N.C., C.L.J., P.C.C., D.H.K., A.L.K.), Cleveland Clinic, OH.,Department of Thoracic and Cardiovascular Surgery (A.P., D.J.), Cleveland Clinic, OH
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute (R.S.T., T.K.M.W., M.C., M.M.F., N.C., C.L.J., P.C.C., D.H.K., A.L.K.), Cleveland Clinic, OH.,Department of Thoracic and Cardiovascular Surgery (A.P., D.J.), Cleveland Clinic, OH
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7
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Hoit BD. Is it time to discard outdated notions of pulmonary hypertension in constrictive pericarditis? Heart 2021; 107:1611-1612. [PMID: 34376490 DOI: 10.1136/heartjnl-2021-319821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Brian D Hoit
- Medicine, Case Western Reserve University and University Hospitals of Cleveland, Cleveland, Ohio, USA
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8
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Lim K, Yang JH, Miranda WR, Chang SA, Jeong DS, Nishimura RA, Schaff H, Soo WM, Greason KL, Oh JK. Clinical significance of pulmonary hypertension in patients with constrictive pericarditis. Heart 2021; 107:1651-1656. [PMID: 34285103 DOI: 10.1136/heartjnl-2021-319149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/08/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We investigated haemodynamics and clinical outcomes according to type of pulmonary hypertension (PH) in patients with constrictive pericarditis (CP). BACKGROUND As the prevalence of CP with concomitant myocardial disease (mixed CP) grows, PH is more commonly seen in patients with CP. However, haemodynamic and outcome data according to the presence or absence of PH are limited. METHODS 150 patients with surgically confirmed CP who underwent echocardiography and cardiac catheterisation within 7 days at two tertiary centres were divided into three groups: no-PH, isolated postcapillary PH (Ipc-PH) and combined postcapillary and precapillary PH (Cpc-PH). Primary outcome was all-cause mortality during follow-up. RESULT In this retrospective cohort study, 110 (73.3%) had PH (mean pulmonary artery pressure ≥25 mm Hg). Cpc-PH, using defined cut-offs for pulmonary vascular resistance (>3 Wood units) or diastolic pulmonary gradient (≥7 mm Hg), was seen in 18 patients (12%). The Cpc-PH group had a higher prevalence of comorbidities (diabetes and atrial fibrillation) and concomitant myocardial disease as an aetiology of CP than other groups. Pulmonary vascular resistance had a significant direct correlation with medial E/e' by Doppler echocardiography (r=0.404, p<0.001). Survival rate was significantly lower in the Cpc-PH than the no-PH (p=0.002) and Ipc-PH (p=0.024) groups. On multivariable analysis, age, New York Heart Association functional class IV, medial e' velocity, Cpc-PH and Ipc-PH were independently associated with long-term mortality. CONCLUSION Combined postcapillary and precapillary PH develops in a subset of patients with CP and is associated with long-term mortality after pericardiectomy.
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Affiliation(s)
- Kyunghee Lim
- Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea (the Republic of)
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of).,Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the republoic of)
| | - William R Miranda
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul, Korea (the Republic of)
| | - Rick A Nishimura
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Hartzell Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Wern Miin Soo
- Department of Cardiology, National University Hospital, Singapore
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jae K Oh
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of).,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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9
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Verbrugge FH, Guazzi M, Testani JM, Borlaug BA. Altered Hemodynamics and End-Organ Damage in Heart Failure: Impact on the Lung and Kidney. Circulation 2020; 142:998-1012. [PMID: 32897746 DOI: 10.1161/circulationaha.119.045409] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Heart failure is characterized by pathologic hemodynamic derangements, including elevated cardiac filling pressures ("backward" failure), which may or may not coexist with reduced cardiac output ("forward" failure). Even when normal during unstressed conditions such as rest, hemodynamics classically become abnormal during stressors such as exercise in patients with heart failure. This has important upstream and downstream effects on multiple organ systems, particularly with respect to the lungs and kidneys. Hemodynamic abnormalities in heart failure are affected by processes that extend well beyond the cardiac myocyte, including important roles for pericardial constraint, ventricular interaction, and altered venous capacity. Hemodynamic perturbations have widespread effects across multiple heart failure phenotypes, ranging from reduced to preserved ejection fraction, acute to chronic disease, and cardiogenic shock to preserved perfusion states. In the lung, hemodynamic derangements lead to the development of abnormalities in ventilatory control and efficiency, pulmonary congestion, capillary stress failure, and eventually pulmonary vascular disease. In the kidney, hemodynamic perturbations lead to sodium and water retention and worsening renal function. Improved understanding of the mechanisms by which altered hemodynamics in heart failure affect the lungs and kidneys is needed in order to design novel strategies to improve clinical outcomes.
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Affiliation(s)
- Frederik H Verbrugge
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.H.V., B.A.B.).,Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Belgium (F.H.V.)
| | - Marco Guazzi
- Cardiology University Department, Heart Failure Unit, University of Milano, IRCCS Policlinico San Donato, Milan, Italy (M.G.)
| | - Jeffrey M Testani
- Section of Cardiovascular Medicine, Yale University, New Haven, CT (J.M.T.)
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.H.V., B.A.B.)
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Constrictive Pericarditis: Differentiating the "Purebred" From the "Mixed Bag". J Am Coll Cardiol 2019; 73:3322-3325. [PMID: 31248554 DOI: 10.1016/j.jacc.2019.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/06/2019] [Indexed: 11/22/2022]
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