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Schoettler FI, Fatehi Hassanabad A, Jadli AS, Patel VB, Fedak PWM. Exploring the role of pericardial miRNAs and exosomes in modulating cardiac fibrosis. Cardiovasc Pathol 2024; 73:107671. [PMID: 38906439 DOI: 10.1016/j.carpath.2024.107671] [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: 03/31/2024] [Revised: 05/26/2024] [Accepted: 06/15/2024] [Indexed: 06/23/2024] Open
Abstract
The potential of the pericardial space as a therapeutic delivery tool for cardiac fibrosis and heart failure (HF) treatment has yet to be elucidated. Recently, miRNAs and exosomes have been discovered to be present in human pericardial fluid (PF). Novel studies have shown characteristic human PF miRNA compositions associated with cardiac diseases and higher miRNA expressions in PF compared to peripheral blood. Five key studies found differentially expressed miRNAs in HF, angina pectoris, aortic stenosis, ventricular tachycardia, and congenital heart diseases with either atrial fibrillation or sinus rhythm. As miRNA-based therapeutics for cardiac fibrosis and HF showed promising results in several in vivo studies for multiple miRNAs, we hypothesize a potential role of miRNA-based therapeutics delivered through the pericardial cavity. This is underlined by the favorable results of the first phase 1b clinical trial in this emerging field. Presenting the first human miRNA antisense drug trial, inhibition of miR-132 by intravenous administration of a novel antisense oligonucleotide, CDR132L, established efficacy in reducing miR-132 in plasma samples in a dose-dependent manner. We screened the literature, provided an overview of the miRNAs and exosomes present in PF, and drew a connection to those miRNAs previously elucidated in cardiac fibrosis and HF. Further, we speculate about clinical implications and potential delivery methods.
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Affiliation(s)
- Friederike I Schoettler
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Surgery, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Ali Fatehi Hassanabad
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Section of Cardiac Surgery, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anshul S Jadli
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada; Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Vaibhav B Patel
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada; Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul W M Fedak
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Section of Cardiac Surgery, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Chong A, Stanton T, Taylor A, Prior D, La Gerche A, Anderson B, Scalia G, Cooke J, Dahiya A, To A, Davis M, Mottram P, Moir S, Playford D, Mahadavan D, Thomas L, Wahi S. 2024 CSANZ Position Statement on Indications, Assessment and Monitoring of Structural and Valvular Heart Disease With Transthoracic Echocardiography in Adults. Heart Lung Circ 2024; 33:773-827. [PMID: 38749800 DOI: 10.1016/j.hlc.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 08/22/2023] [Accepted: 11/01/2023] [Indexed: 06/25/2024]
Abstract
Transthoracic echocardiography (TTE) is the most widely available and utilised imaging modality for the screening, diagnosis, and serial monitoring of all abnormalities related to cardiac structure or function. The primary objectives of this document are to provide (1) a guiding framework for treating clinicians of the acceptable indications for the initial and serial TTE assessments of the commonly encountered cardiovascular conditions in adults, and (2) the minimum required standard for TTE examinations and reporting for imaging service providers. The main areas covered within this Position Statement pertain to the TTE assessment of the left and right ventricles, valvular heart diseases, pericardial diseases, aortic diseases, infective endocarditis, cardiac masses, pulmonary hypertension, and cardiovascular diseases associated with cancer treatments or cardio-oncology. Facilitating the optimal use and performance of high quality TTEs will prevent the over or under-utilisation of this resource and unnecessary downstream testing due to suboptimal or incomplete studies.
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Affiliation(s)
- Adrian Chong
- Department of Cardiology, Princess Alexandra Hospital, Mater Hospital Brisbane, University of Queensland, Brisbane, Qld, Australia
| | - Tony Stanton
- Sunshine Coast University Hospital, School of Health University of Sunshine Coast, School of Medicine and Dentistry Griffith University, Birtinya, Qld, Australia
| | - Andrew Taylor
- Department of Cardiology, Royal Melbourne Hospital, Alfred Hospital, Melbourne, Vic, Australia
| | - David Prior
- Albury Wodonga Health, Albury, NSW, Australia
| | - Andre La Gerche
- St Vincent's Hospital, Baker Heart and Diabetes Institute, University of Melbourne, Melbourne, Vic, Australia
| | - Bonita Anderson
- Cardiac Sciences Unit, The Prince Charles Hospital, Queensland University of Technology, Brisbane, Qld, Australia
| | - Gregory Scalia
- The Prince Charles Hospital, University of Queensland, Brisbane, Qld, Australia
| | - Jennifer Cooke
- Department of Cardiology, Eastern Health, Monash University, Melbourne, Vic, Australia
| | - Arun Dahiya
- Department of Cardiology, Princess Alexandra Hospital, Logan Hospital, Griffith University, Brisbane, Qld, Australia
| | - Andrew To
- Department of Cardiology, Health New Zealand Waitemata, Auckland, New Zealand
| | | | - Philip Mottram
- Victorian Heart Institute, Monash University, Melbourne, Vic, Australia
| | - Stuart Moir
- Victorian Heart Institute, Monash University, Melbourne, Vic, Australia
| | | | - Devan Mahadavan
- Department of Cardiology, Queen Elizabeth Hospital, Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Westmead Clinical School University of Sydney, South West Clinical School University of New South Wales, Sydney, NSW, Australia
| | - Sudhir Wahi
- Department of Cardiology, Princess Alexandra Hospital, University of Queensland, Brisbane, Qld, Australia.
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Liu G, Chen T, Zhang X, Hu B, Shi H. Immune checkpoint inhibitor-associated cardiovascular toxicities: A review. Heliyon 2024; 10:e25747. [PMID: 38434280 PMCID: PMC10907684 DOI: 10.1016/j.heliyon.2024.e25747] [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: 07/19/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionary effects on therapeutic strategies for multiple malignancies. Their efficacy depends on their ability to reactivate the host immune system to fight cancer cells. However, adverse reactions to ICIs are common and involve several organs, limiting their use in clinical practice. Although the incidence of cardiovascular toxicity is relatively low, it is associated with serious consequences and high mortality rates. The primary cardiovascular toxicities include myocarditis, pericarditis, Takotsubo syndrome, arrhythmia, vasculitis, acute coronary syndrome, and venous thromboembolism. Currently, the mechanism underlying ICI-associated cardiovascular toxicity remains unclear and underexplored. The diagnosis and monitoring of ICI-associated cardiovascular toxicities mainly include the following indicators: symptoms, signs, laboratory examination, electrocardiography, imaging, and pathology. Treatments are based on the grade of cardiovascular toxicity and mainly include drug withdrawal, corticosteroid therapy, immunosuppressants, and conventional cardiac treatment. This review focuses on the incidence, underlying mechanisms, clinical manifestations, diagnoses, and treatment strategies.
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Affiliation(s)
- Guihong Liu
- Guihong Liu Department of Biotherapy, State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Chen
- Tao Chen Department of Cardiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xin Zhang
- Guihong Liu Department of Biotherapy, State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Binbin Hu
- Guihong Liu Department of Biotherapy, State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Huashan Shi
- Guihong Liu Department of Biotherapy, State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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Li D, Chen R, Huang C, Zhang G, Li Z, Xu X, Wang B, Li B, Chu XM. Comprehensive bioinformatics analysis and systems biology approaches to identify the interplay between COVID-19 and pericarditis. Front Immunol 2024; 15:1264856. [PMID: 38455049 PMCID: PMC10918693 DOI: 10.3389/fimmu.2024.1264856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 02/08/2024] [Indexed: 03/09/2024] Open
Abstract
Background Increasing evidence indicating that coronavirus disease 2019 (COVID-19) increased the incidence and related risks of pericarditis and whether COVID-19 vaccine is related to pericarditis has triggered research and discussion. However, mechanisms behind the link between COVID-19 and pericarditis are still unknown. The objective of this study was to further elucidate the molecular mechanisms of COVID-19 with pericarditis at the gene level using bioinformatics analysis. Methods Genes associated with COVID-19 and pericarditis were collected from databases using limited screening criteria and intersected to identify the common genes of COVID-19 and pericarditis. Subsequently, gene ontology, pathway enrichment, protein-protein interaction, and immune infiltration analyses were conducted. Finally, TF-gene, gene-miRNA, gene-disease, protein-chemical, and protein-drug interaction networks were constructed based on hub gene identification. Results A total of 313 common genes were selected, and enrichment analyses were performed to determine their biological functions and signaling pathways. Eight hub genes (IL-1β, CD8A, IL-10, CD4, IL-6, TLR4, CCL2, and PTPRC) were identified using the protein-protein interaction network, and immune infiltration analysis was then carried out to examine the functional relationship between the eight hub genes and immune cells as well as changes in immune cells in disease. Transcription factors, miRNAs, diseases, chemicals, and drugs with high correlation with hub genes were predicted using bioinformatics analysis. Conclusions This study revealed a common gene interaction network between COVID-19 and pericarditis. The screened functional pathways, hub genes, potential compounds, and drugs provided new insights for further research on COVID-19 associated with pericarditis.
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Affiliation(s)
- Daisong Li
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ruolan Chen
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chao Huang
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guoliang Zhang
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhaoqing Li
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaojian Xu
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Banghui Wang
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bing Li
- Department of Genetics and Cell Biology, Basic Medical College, Qingdao University, Qingdao, China
- Department of Dermatology, The Affiliated Haici Hospital of Qingdao University, Qingdao, China
| | - Xian-Ming Chu
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
- Department of Cardiology, The Affiliated Cardiovascular Hospital of Qingdao University, Qingdao, China
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5
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Li B, Dong C, Pan G, Liu R, Tong M, Xu J, Liu S. Outcomes and Risk Factors Associated with Pericardiectomy in Patients with Constrictive Pericarditis: A Retrospective Study from China. Ann Thorac Cardiovasc Surg 2024; 30:24-00036. [PMID: 38811208 PMCID: PMC11163141 DOI: 10.5761/atcs.oa.24-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/28/2024] [Indexed: 05/31/2024] Open
Abstract
PURPOSE Pericardiectomy is the definitive treatment option for constrictive pericarditis and is associated with a high prevalence of morbidity and mortality. However, information on the associated outcomes and risk factors is limited. We aimed to report the mid-term outcomes of pericardiectomy from a single center in China. METHODS We retrospectively reviewed data collected from patients who underwent pericardiectomy at our institute from April 2018 to January 2023. RESULTS Eighty-six consecutive patients (average age, 46.1 ± 14.7 years; 68.6 men) underwent pericardiectomy through midline sternotomy. The most common etiology was idiopathic (n = 60, 69.8%), and 82 patients (95.3%) were in the New York Heart Association function class III/IV. In all, 32 (37.2%) patients underwent redo sternotomies, 36 (41.9%) underwent a concomitant procedure, and 39 (45.3%) required cardiopulmonary bypass. The 30-day mortality rate was 5.8%, and the 1-year and 5-year survival rates were 88.3% and 83.5%, respectively. Multivariable analysis revealed that preoperative mitral insufficiency (MI) ≥moderate (hazard ratio [HR], 6.435; 95% confidence interval [CI] [1.655-25.009]; p = 0.007) and partial pericardiectomy (HR, 11.410; 95% CI [3.052-42.663]; p = 0.000) were associated with increased 5-year mortality. CONCLUSION Pericardiectomy remains a safe operation for constrictive pericarditis with optimal mid-term outcomes.
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Affiliation(s)
- Bin Li
- Cardiac Surgery Department, Peking University International Hospital, Beijing, China
| | - Chao Dong
- Cardiac Surgery Department, Peking University International Hospital, Beijing, China
| | - Guangyu Pan
- Cardiac Surgery Department, Peking University International Hospital, Beijing, China
| | - Ruofan Liu
- Cardiac Surgery Department, Peking University International Hospital, Beijing, China
| | - Minghui Tong
- Cardiac Surgery Department, Peking University International Hospital, Beijing, China
| | - Jianping Xu
- Cardiac Surgery Department, Peking University International Hospital, Beijing, China
| | - Shen Liu
- Cardiac Surgery Department, Peking University International Hospital, Beijing, China
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Hassanabad AF, Deniset JF, Fedak PWM. Pericardial Inflammatory Mediators That Can Drive Postoperative Atrial Fibrillation in Cardiac Surgery Patients. Can J Cardiol 2023; 39:1090-1102. [PMID: 37301368 DOI: 10.1016/j.cjca.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 06/12/2023] Open
Abstract
Postoperative atrial fibrillation (POAF) is a common dysrhythmia that affects a significant number of patients undergoing cardiac surgery. Many studies aim to better understand this complex postsurgical complication by analysing circulating biomarkers in patients who develop POAF. More recently, the pericardial space was shown to contain inflammatory mediators that could trigger POAF. In this review we summarise recent studies that examine the immune mediators present in the pericardial space and their potential implications for the pathophysiology of POAF in cardiac surgery patients. Ongoing research in this area should better delineate the multifactorial etiology of POAF, where specific markers may be targeted to reduce the incidence of POAF and improve outcomes for this patient population.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Justin F Deniset
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul W M Fedak
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Elsliger S, Saucier J, Schneider A, El Helou A. Spinal cord stimulation for refractory pericarditis: a case report and a review of the mechanism of action. FRONTIERS IN PAIN RESEARCH 2023; 4:1174044. [PMID: 37476333 PMCID: PMC10354338 DOI: 10.3389/fpain.2023.1174044] [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] [Received: 03/24/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023] Open
Abstract
Background and objectives In recent years, spinal cord stimulation (SCS) has emerged as a promising management option for chronic pain of multiple etiologies. While its effectiveness has been strongly suggested in many patients, the exact mechanism of action of SCS is incompletely understood. This article reviews the leading mechanisms underlying the analgesic and cardiovascular effects of SCS and reports its novel benefits in a case of recurrent pericarditis. Literature review Throughout history, the analgesic properties of SCS were thought to arise via stimulation of the spinothalamic tract. Although this mechanism has been thoroughly reported, new research and patient outcomes from SCS have revealed various additional properties that cannot be fully explained by this mechanism alone. Evidence suggests that SCS enhances calcitonin gene-related peptide release and modulates inflammatory cytokine secretion, sympathetic tone, and inhibitory neurotransmitter secretion. These distinct mechanisms likely collectively contribute to the therapeutic effects of SCS on the cardiovascular system and pain management. Case report We report the case of a 48-year-old male patient with recurrent pericarditis, characterized by refractory angina-like pain and reduced left ventricular ejection fraction (LVEF). After 1 year of having a spinal cord stimulator implanted, the patient is free from pain and narcotics, with a reduction of 428 mg equivalent dose of morphine. The patient's LVEF increased from 40% to 45% without changes to his previous medical treatment. This is the first reported case of refractory pericarditis managed with spinal cord stimulation. Conclusion Recognizing the improved pain management, reduced narcotic usage, and improved LVEF in our patient following SCS is critical to paving the way toward a complete understanding of the mechanism of action of SCS. This case reveals the therapeutic potential of SCS for cardiovascular pathologies other than refractory angina pectoris.
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Affiliation(s)
- Simon Elsliger
- Centre de Formation Medicale du Nouveau Brunswick, Universite de Sherbrook, Moncton, NB, Canada
| | - Jacob Saucier
- Centre de Formation Medicale du Nouveau Brunswick, Universite de Sherbrook, Moncton, NB, Canada
| | - Andre Schneider
- Centre de Formation Medicale du Nouveau Brunswick, Universite de Sherbrook, Moncton, NB, Canada
- Department of Anesthesia and Pain Medicine, Vitalite Health Network, Bathurst, NB, Canada
| | - Antonios El Helou
- Centre de Formation Medicale du Nouveau Brunswick, Universite de Sherbrook, Moncton, NB, Canada
- Division of Neurosurgery, Horizon Health Network, Moncton, NB, Canada
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
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Zhang R, Du J, Liu M. Post-cardiac injury syndrome occurred two months after permanent dual-chamber pacemaker implantation. BMC Cardiovasc Disord 2023; 23:259. [PMID: 37208627 DOI: 10.1186/s12872-023-03252-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/20/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Post cardiac injury syndrome (PCIS) is characterized by the development of pericarditis with or without pericardial effusion due to a recent cardiac injury. The relatively low incidence makes diagnosis of PCIS after implantation of a pacemaker easily be overlooked or underestimated. This report describes one typical case of PCIS. CASE PRESENTATION We present a case report of a 94-year-old male with a history of sick sinus syndrome managed with a dual-chamber pacemaker who presented with PCIS after two months of pacemaker implantation. He gradually developed chest discomfort, weakness, tachycardia and paroxysmal nocturnal dyspnea and cardiac tamponade after two months of pacemaker. Post-cardiac injury syndrome related to dual-chamber pacemaker implantation was considered based on exclusion of other possible causes of pericarditis. His therapy was drainage of pericardial fluid and managed with a combination of colchicine and support therapy. He was placed on long-term colchicine therapy to prevent any recurrences. CONCLUSION This case illustrated that PCIS can occur after minor myocardial injury, and that the possibility of PCIS should be considered if there is a history of possible cardiac insult.
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Affiliation(s)
- Ruiqi Zhang
- Department of Geriatrics, Peking University First Hospital, 100034, Beijing, People's Republic of China
| | - Jiali Du
- Department of Geriatrics, Peking University First Hospital, 100034, Beijing, People's Republic of China
| | - Meilin Liu
- Department of Geriatrics, Peking University First Hospital, 100034, Beijing, People's Republic of China.
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Masarweh OM, Vyas P, Knapp TM, Gonzalez-Morales U, Ammar A. A Case of Acute Purulent Streptococcus pneumoniae Pericarditis Causing Tamponade and Cardiac Arrest in a COVID-19-Infected Patient. Cureus 2023; 15:e39467. [PMID: 37362487 PMCID: PMC10290255 DOI: 10.7759/cureus.39467] [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] [Received: 05/12/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Purulent pericarditis due to Streptococcus pneumoniae (S. pneumoniae) has been increasingly rare since the advent of antibiotics; however, it still carries a high mortality rate, especially in the setting of tamponade. Bedside transthoracic echocardiogram (TTE) is a useful, cheap, and underutilized tool that can aid in the diagnosis, treatment, and further management of patients presenting to the emergency department with chest pain, as well as during cardiac resuscitation. In this report, we present a case of an acute purulent S. pneumoniae pericarditis of an unknown primary source in a patient coinfected with coronavirus disease 2019 (COVID-19) pneumonia, resulting in cardiac tamponade and cardiac arrest that resolved with the aid of bedside echocardiography-guided pericardiocentesis. We attempt to highlight the importance of clinicians using echocardiography to aid in their clinical decision-making, demonstrating it as a fast and effective tool capable of providing instantaneous feedback.
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Affiliation(s)
- Omar M Masarweh
- Internal Medicine, University of Central Florida, Kissimmee, USA
| | - Parag Vyas
- Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Thomas M Knapp
- Medicine, University of Central Florida College of Medicine, Orlando, USA
| | | | - Ali Ammar
- Cardiology, Orlando Health, Orlando, USA
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Shahid R, Jin J, Hope K, Tunuguntla H, Amdani S. Pediatric Pericarditis: Update. Curr Cardiol Rep 2023; 25:157-170. [PMID: 36749541 PMCID: PMC9903287 DOI: 10.1007/s11886-023-01839-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW While there have now been a variety of large reviews on adult pericarditis, this detailed review specifically focuses on the epidemiology, clinical presentation, diagnosis, and management of pediatric pericarditis. We have tried to highlight most pediatric studies conducted on this topic, with special inclusion of important adult studies that have shaped our understanding of and management for acute and recurrent pericarditis. RECENT FINDINGS We find that the etiology of pediatric pericarditis differs from adult patients with pericarditis and has evolved over the years. Also, with the current COVID-19 pandemic, it is important for pediatric clinicians to be aware of pericardial involvement both due to the infection and from vaccination. Oftentimes, pericarditis maybe the only cardiac involvement in children with COVID-19, and so caregivers should maintain a high index of suspicion when they encounter children with pericarditis. Large-scale contemporary epidemiological data regarding incidence and prevalence of both acute and recurrent pericarditis is lacking in pediatrics, and future studies should focus on highlighting this important research gap. Most of the current management strategies for pediatric pericarditis are from experiences gathered from adult data. Pediatric multicenter trials are warranted to understand the best management strategy for those with acute and recurrent pericarditis. CASE VIGNETTE A 6-year-old child with a past history of pericarditis almost 2 months ago comes in with a 2-day history of chest pain and fever. Per mother, he stopped his steroids about 2 weeks ago, and for the last 2 days has had a temperature of 102F and has been complaining of sharp mid-sternal chest pain that gets worse when he lies down and is relieved when he sits up and leans forward. On examination, he is tachycardic (heart rate 160 bpm), with normal blood pressure for age. He appears to be in pain (5/10), and on auscultation has a pericardial friction rub. His lab studies are notable for elevated white blood cell count and inflammatory markers (CRP and ESR). His electrocardiogram reveals sinus tachycardia and diffuse ST-elevation in all precordial leads. His echocardiogram demonstrates normal biventricular function and a trace pericardial effusion. His cardiac MRI confirms recurrent pericarditis. He is started on indomethacin and colchicine. He has complete resolution of his symptoms by day 3 of admission and is discharged with close follow-up.
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Affiliation(s)
- Rida Shahid
- grid.239578.20000 0001 0675 4725Department of Pediatric Cardiology, Cleveland Clinic Children’s Hospital, Cleveland, OH USA
| | - Justin Jin
- grid.413808.60000 0004 0388 2248Division of Pediatric Cardiology, Northwestern Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Kyle Hope
- grid.39382.330000 0001 2160 926XLillie Frank Abercrombie Division of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
| | - Hari Tunuguntla
- grid.39382.330000 0001 2160 926XLillie Frank Abercrombie Division of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
| | - Shahnawaz Amdani
- grid.239578.20000 0001 0675 4725Department of Pediatric Cardiology, Cleveland Clinic Children’s Hospital, Cleveland, OH USA
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11
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Kostelecky N, Kreutz K, Lin CY. Sensitivity of Antemortem Imaging for Pericarditis: An Institutional Experience. Am J Forensic Med Pathol 2023; 44:21-24. [PMID: 36580385 DOI: 10.1097/paf.0000000000000808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
ABSTRACT Pericarditis is a challenging diagnosis with nonspecific manifestations, significant clinical implications, and possible mortality. The advancement of imaging, such as echocardiography, computed tomography (CT), and magnetic resonance imaging (MRI), has improved the sensitivity of diagnosis, although limitations remain. In this study, we investigated the prevalence of pericarditis identified at autopsy and correlated these findings with antemortem imaging studies and clinical information. Thirty-four decedents were identified in our archival autopsy records (prevalence, 1.23%) from 2010 to 2021 with a postmortem diagnosis of pericarditis. Thirty-five antemortem imaging studies were performed on 32 decedents, of which CT was the most common (18/35, 51.4%). The sensitivity of antemortem imaging was poor, with CT showing the highest sensitivity at 16.7% (3/18), while echocardiography studies, transthoracic (TTE) and transesophageal (TEE), each had a sensitivity of 0.0%. Pericarditis was determined as the immediate cause of death by autopsy in 13 decedents, of which 3 were diagnosed antemortem. It was considered contributory to the death in 6 decedents, none of which were diagnosed antemortem. In summary, antemortem imaging has limited utility in the diagnosis of pericarditis. It is imperative to examine the pericardium during autopsy to identify a possible cause of death or contributing factor.
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Affiliation(s)
- Nicolas Kostelecky
- From the Department of Pathology, Northwestern Memorial Hospital Feinberg School of Medicine, Chicago, IL
| | - Kasey Kreutz
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO
| | - Chieh-Yu Lin
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO
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Kaemmerer AS, Alkhalaileh K, Suleiman MN, Kopp M, Hauer C, May MS, Uder M, Weyand M, Harig F. Pericardial tamponade, a diagnostic chameleon: from the historical perspectives to contemporary management. J Cardiothorac Surg 2023; 18:60. [PMID: 36739433 PMCID: PMC9898697 DOI: 10.1186/s13019-023-02174-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/28/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pericardial tamponade (PT) early after cardiac surgery is a challenging clinical entity, not infrequently misrecognized and often only detected late in its course. Because the clinical signs of pericardial tamponade can be very unspecific, a high degree of initial suspicion is required to establish the diagnosis. In addition to clinical examination the deployment of imaging techniques is almost always mandatory in order to avoid delays in diagnosis and to initiate any necessary interventions, such as pericardiocentesis or direct cardiac surgical interventions. After a brief overview of how knowledge of PT has developed throughout history, we report on an atypical life-threatening cardiac tamponade after cardiac surgery. A 74-year-old woman was admitted for elective biological aortic valve replacement and aorto-coronary-bypass grafting (left internal mammary artery to left anterior descending artery, single vein graft to right coronary artery). On the 10th postoperative day, the patient unexpectedly deteriorated. She rapidly developed epigastric pain radiating to the left upper abdomen, and features of low peripheral perfusion and shock. There were no clear signs of pericardial tamponade either clinically or echocardiographically. Therefore, for further differential diagnosis, a contrast-enhanced computed tomography scan was performed under clinical suspicion of acute abdomen. Unexpectedly, active bleeding distally from the right coronary anastomosis was revealed. While the patient was prepared for operative revision, she needed cardiopulmonary resuscitation, which was successful. Intraoperatively, the source of bleeding was located and surgically relieved. The subsequent postoperative course was uneventful. CONCLUSIONS In the first days after cardiac surgery, the occurrence of life-threatening situations, such as cardiac tamponade, must be expected. Especially if the symptoms are atypical, the entire diagnostic armamentarium must be applied to identify the origin of the complaints, which may be cardiac, but also non-cardiac. CENTRAL MESSAGE A high level of suspicion, immediate diagnostic confirmation, and rapid treatment are required to recognize and successfully treat such an emergency (Fig. 5). PERSPECTIVE Pericardial tamponade should always be considered as a complication of cardiac surgery, even when symptoms are atypical. The full range of diagnostic tools must be used to identify the origin of the complaints, which may be cardiac, but also non-cardiac (Fig. 5).
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Affiliation(s)
- Ann-Sophie Kaemmerer
- grid.5330.50000 0001 2107 3311Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Khaleel Alkhalaileh
- grid.5330.50000 0001 2107 3311Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Mathieu N. Suleiman
- grid.5330.50000 0001 2107 3311Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Markus Kopp
- grid.5330.50000 0001 2107 3311Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Christine Hauer
- grid.5330.50000 0001 2107 3311Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias S. May
- grid.5330.50000 0001 2107 3311Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Uder
- grid.5330.50000 0001 2107 3311Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Weyand
- grid.5330.50000 0001 2107 3311Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Frank Harig
- grid.5330.50000 0001 2107 3311Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
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Sarda AK, Thute P. Importance of ECG in the Diagnosis of Acute Pericarditis and Myocardial Infarction: A Review Article. Cureus 2022; 14:e30633. [DOI: 10.7759/cureus.30633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/24/2022] [Indexed: 11/05/2022] Open
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Zheng Y, Xu L, Dong N, Li F. NLRP3 inflammasome: The rising star in cardiovascular diseases. Front Cardiovasc Med 2022; 9:927061. [PMID: 36204568 PMCID: PMC9530053 DOI: 10.3389/fcvm.2022.927061] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/18/2022] [Indexed: 11/21/2022] Open
Abstract
Cardiovascular diseases (CVDs) are the prevalent cause of mortality around the world. Activation of inflammasome contributes to the pathological progression of cardiovascular diseases, including atherosclerosis, abdominal aortic aneurysm, myocardial infarction, dilated cardiomyopathy, diabetic cardiomyopathy, heart failure, and calcific aortic valve disease. The nucleotide oligomerization domain-, leucine-rich repeat-, and pyrin domain-containing protein 3 (NLRP3) inflammasome plays a critical role in the innate immune response, requiring priming and activation signals to provoke the inflammation. Evidence shows that NLRP3 inflammasome not only boosts the cleavage and release of IL-1 family cytokines, but also leads to a distinct cell programmed death: pyroptosis. The significance of NLRP3 inflammasome in the CVDs-related inflammation has been extensively explored. In this review, we summarized current understandings of the function of NLRP3 inflammasome in CVDs and discussed possible therapeutic options targeting the NLRP3 inflammasome.
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Lei H, Wang D, Wang H, Xu Y. Constrictive pericarditis caused by viral myocarditis in children: a brief report. J Cardiothorac Surg 2022; 17:215. [PMID: 36031615 PMCID: PMC9420253 DOI: 10.1186/s13019-022-01969-6] [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: 07/17/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background Constrictive pericarditis is more common in adults and has a low incidence in children. Here is a case of coxsackie virus induced myocarditis in children, resulting in constrictive pericarditis.
Conclusion Chronic inflammation of viral myocarditis can cause inflammatory changes of pericarditis and cause constrictive pericarditis.
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Mire Waberi M, Sheikh Hassan M, Hashi Mohamed A, Said A, Akyuz H. A 15-year-old girl with pericardial tuberculosis complicated by cardiac tamponade: A case report in Somalia. Ann Med Surg (Lond) 2022; 80:104252. [PMID: 36045809 PMCID: PMC9422315 DOI: 10.1016/j.amsu.2022.104252] [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: 06/22/2022] [Revised: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction and importance Pericarditis is a common illness that can appear in a variety of clinical settings and has numerous causes. In developing nations where tuberculosis is still a serious public health issue, more than 50% of cases of pericarditis are related to tuberculosis. Case presentation There was no history of TB, alcoholism, IV drug abuse, immunosuppressant, or corticosteroid use. On examination, she had a fever, tachycardia, pulsus paradoxus of 10 mmHg, hypotension, tachypnea, and a distended jugular vein. On auscultation, her heartbeats were muffled, and accompanied by a pericardial rub. Laboratory investigation showed low hematocrit and a high WBC count with lymphocyte predominance. ESR and CRP levels were elevated. Her chest X-ray revealed an enlargement of the cardiac silhouette. The ECG showed low voltage complexes. Echocardiography showed circumferential 30 mm × 25 mm pericardial effusion with fibrin strands in the visceral pericardium. An emergency pericardiocentesis was performed under the guidance of transthoracic echocardiography using sub-xiphoidal standards. Microbiologic analysis of the pericardial fluid confirmed tuberculosis. After successful pericardiocenthesis, the patient's condition improved massively. After three days of pericardiocentasis drainage, TB treatment was started and she was discharged for outpatient flow up. Clinical discussion Tuberculous pericarditis is a serious tuberculosis (TB) complication that can be difficult to diagnose and often goes undetected, leading to late complications such as constrictive pericarditis and cardiac tamponade, which lead to increased mortality. This current case illustrates a young female patient presenting with isolated TB pericarditis complicated by cardiac tamponade. She had massive improvement following pericardiocentesis and anti-TB treatment. Conclusion In Africa, tuberculous pericarditis should be considered as a differential diagnosis in any patient presenting with moderate to massive pericardial effusion. A high index of suspicion is required for the diagnosis of extrapulmonary TB pericarditis, especially in patients without known risk factors. A previously healthy young female patient was admitted with isolated tuberculosis pericarditis complicated by cardiac temponade. Transthoracic echocardiography revealed extensive pericardial effusion causing cardiac temponade. Microbiologic analysis of the pericardial fluid confirmed tuberculosis. She had massive improvement after she was successfully managed with pericardiocenthesis and anti-TB medication.
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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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Tuberculosis of the Heart: A Diagnostic Challenge. Tomography 2022; 8:1649-1665. [PMID: 35894002 PMCID: PMC9326682 DOI: 10.3390/tomography8040137] [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: 04/12/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/17/2022] Open
Abstract
Tuberculosis of the heart is relatively rare and presents a significant diagnostic difficulty for physicians. It is the leading cause of death from infectious illness. It is one of the top 10 leading causes of death worldwide, with a disproportionate impact in low- and middle-income nations. The radiologist plays a pivotal role as CMR is a non-invasive radiological method that can aid in identifying potential overlap and differential diagnosis between tuberculosis, mass lesions, pericarditis, and myocarditis. Regardless of similarities or overlap in observations, the combination of clinical and certain particular radiological features, which are also detected by comparison to earlier and follow-up CMR scans, may aid in the differential diagnosis. CMR offers a significant advantage over echocardiography for detecting, characterizing, and assessing cardiovascular abnormalities. In conjunction with clinical presentation, knowledge of LGE, feature tracking, and parametric imaging in CMR may help in the early detection of tuberculous myopericarditis and serve as a surrogate for endomyocardial biopsy resulting in a quicker diagnosis and therapy. This article aims to explain the current state of cardiac tuberculosis, the diagnostic utility of CMR in tuberculosis (TB) patients, and offer an overview of the various imaging and laboratory procedures used to detect cardiac tuberculosis.
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Kashiwagi Y, Yoshida J, Nagoshi T, Hoshino S, Yoshitake M, Hongo K, Kunihara T, Yoshimura M. Constrictive Pericarditis with Cardiac Ascites Caused Spontaneous Bacterial Peritonitis. Intern Med 2022; 61:1857-1861. [PMID: 34776488 PMCID: PMC9259821 DOI: 10.2169/internalmedicine.8332-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Patients with constrictive pericarditis (CP) typically present with symptoms related to right-sided heart failure, such as cardiac ascites. Spontaneous bacterial peritonitis (SBP) usually arises in association with ascites secondary to hepatic cirrhosis. We herein report a rare case of CP in which SBP developed due to cardiac ascites, even in the absence of cirrhosis. In this case, pericardiectomy improved both the hemodynamics and the ascites, while therapy with diuretics alone was insufficient. It is important to consider SBP in the differential diagnosis when any abdominal symptoms or an inflammatory response is found in patients with heart failure and cardiac ascites.
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Affiliation(s)
- Yusuke Kashiwagi
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Jun Yoshida
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Tomohisa Nagoshi
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Satoshi Hoshino
- Department of Cardiac Surgery, The Jikei University School of Medicine, Japan
| | - Michio Yoshitake
- Department of Cardiac Surgery, The Jikei University School of Medicine, Japan
| | - Kenichi Hongo
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Takashi Kunihara
- Department of Cardiac Surgery, The Jikei University School of Medicine, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
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20
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Divchev D, Schnurbus M, Schieffer B. [What's new in pericardial disease?]. Dtsch Med Wochenschr 2022; 147:704-710. [PMID: 35636422 DOI: 10.1055/a-1593-9470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pericardial disease represents a large diversity of inflammation related injury of the pericardium. Multifactorial causes may contribute to acute and recurrent pericarditis, pericardial effusion without major hemodynamic compromise, cardiac tamponade or constrictive pericarditis. Currently, inflammatory pericardial pathologies are observed in cases of SARS-CoV-2-infection or after vaccination. Beside established anti-inflammatory therapeutic strategies with NSAID, corticosteroids and colchicine, auto-inflammation and inflammasomes seam to offer more specific targets for advanced treatment options.
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Affiliation(s)
- Dimitar Divchev
- Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Phillips-Universität Marburg, Universitätsklinik Gießen und Marburg, Campus Marburg
| | - Mareike Schnurbus
- Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Phillips-Universität Marburg, Universitätsklinik Gießen und Marburg, Campus Marburg
| | - Bernhard Schieffer
- Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Phillips-Universität Marburg, Universitätsklinik Gießen und Marburg, Campus Marburg
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21
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Liguori C, Tamburrini S, Ferrandino G, Leboffe S, Rosano N, Marano I. Role of CT and MRI in Cardiac Emergencies. Tomography 2022; 8:1386-1400. [PMID: 35645398 PMCID: PMC9149871 DOI: 10.3390/tomography8030112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/25/2022] Open
Abstract
Current strategies for the evaluation of patients with chest pain have significantly changed thanks to the implemented potentiality of CT and MRI. The possible fatal consequences and high malpractice costs of missed acute coronary syndromes lead to unnecessary hospital admissions every year. CT provides consistent diagnostic support, mainly in suspected coronary disease in patients with a low or intermediate pre-test risk. Moreover, it can gain information in the case of cardiac involvement in pulmonary vascular obstructive disease. MRI, on the other hand, has a leading role in the condition of myocardial damage irrespective of the underlying inflammatory or stress related etiology. This article discusses how radiology techniques (CT and MRI) can impact the diagnostic workflow of the most common cardiac and vascular pathologies that are responsible for non-traumatic chest pain admissions to the Emergency Department.
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22
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Lai FTT, Li X, Peng K, Huang L, Ip P, Tong X, Chui CSL, Wan EYF, Wong CKH, Chan EWY, Siu DCW, Wong ICK. Carditis After COVID-19 Vaccination With a Messenger RNA Vaccine and an Inactivated Virus Vaccine : A Case-Control Study. Ann Intern Med 2022; 175:362-370. [PMID: 35073155 PMCID: PMC8814917 DOI: 10.7326/m21-3700] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Case reports of carditis after BNT162b2 vaccination are accruing worldwide. OBJECTIVE To examine the association of BNT162b2 and CoronaVac (Sinovac) vaccination with carditis. DESIGN Case-control study with hospital control participants. SETTING Territory-wide, public health care database with linkage to population-based vaccination records in Hong Kong. PATIENTS Inpatients aged 12 years or older first diagnosed with carditis were selected as case patients. All other hospitalized patients without carditis were treated as control participants. Ten control participants were randomly matched with each case patient by age, sex, and admission date. INTERVENTION Vaccination with BNT162b2 or CoronaVac. MEASUREMENTS Incident diagnosis of carditis based on the International Classification of Diseases, Ninth Revision, and elevated troponin levels. RESULTS A total of 160 case patients and 1533 control participants were included. Incidence of carditis per 100 000 doses of CoronaVac and BNT162b2 administered was estimated to be 0.31 (95% CI, 0.13 to 0.66) and 0.57 (CI, 0.36 to 0.90), respectively. Multivariable analyses showed that recipients of the BNT162b2 vaccine had higher odds of carditis (adjusted odds ratio [OR], 3.57 [CI, 1.93 to 6.60]) than unvaccinated persons. Stratified by sex, the OR was 4.68 (CI, 2.25 to 9.71) for males and 2.22 (CI, 0.57 to 8.69) for females receiving the BNT162b2 vaccine. The ORs for adults and adolescents receiving the BNT162b2 vaccine were 2.41 (CI, 1.18 to 4.90) and 13.79 (CI, 2.86 to 110.38), respectively. Subanalysis showed an OR of 9.29 (CI, 3.94 to 21.91) for myocarditis and 1.06 (CI, 0.35 to 3.22) for pericarditis associated with BNT162b2. The risk was mainly seen after the second dose of BNT162b2 rather than the first. No association between CoronaVac and carditis with a magnitude similar to that for BNT162b2 was seen. LIMITATION Limited sample size, absence of electrocardiography and other clinical investigative data, and unrecorded overseas vaccination exposure. CONCLUSION Despite a low absolute risk, there is an increased risk for carditis associated with BNT162b2 vaccination. This elevated risk should be weighed against the benefits of vaccination. PRIMARY FUNDING SOURCE Health and Medical Research Fund.
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Affiliation(s)
- Francisco Tsz Tsun Lai
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, and Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China (F.T.T., E.W.Y.)
| | - Xue Li
- Department of Medicine and Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, and Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China (X.L.)
| | - Kuan Peng
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China (K.P., L.H.)
| | - Lei Huang
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China (K.P., L.H.)
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China (P.I.)
| | - Xinning Tong
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China (X.T., D.C.W.)
| | - Celine Sze Ling Chui
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Science and Technology Park, and the School of Nursing and School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China (C.S.L.)
| | - Eric Yuk Fai Wan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, and Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, and Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China (E.Y.F., C.K.H.)
| | - Carlos King Ho Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, and Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, and Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China (E.Y.F., C.K.H.)
| | - Esther Wai Yin Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, and Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China (F.T.T., E.W.Y.)
| | - David Chung Wah Siu
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China (X.T., D.C.W.)
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, and Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China, and Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom (I.C.K.)
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Melendo-Viu M, Marchán-Lopez Á, Guarch CJL, Roubín SR, Abu-Assi E, Meneses RT, Ynsaurriaga FA, Hernandez AV, Bueno H. A systematic review and meta-analysis of randomized controlled trials evaluating pharmacologic therapies for acute and recurrent pericarditis. Trends Cardiovasc Med 2022:S1050-1738(22)00024-X. [DOI: 10.1016/j.tcm.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 02/08/2023]
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Zhao B, Zhang J, Li Y, Feng X, Mao S, Yin Z, Liu L, Song D, Wang S. Prevalence, Predictors, and Clinical Presentation of Acute Pericardial Effusion Following Percutaneous Coronary Intervention. Front Cardiovasc Med 2022; 8:759164. [PMID: 35087880 PMCID: PMC8787085 DOI: 10.3389/fcvm.2021.759164] [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: 08/16/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Iatrogenic pericardial effusion (PE) has been demonstrated to lead to cardiac injury as a sign of systemic inflammatory response. Objectives: This study sought to determine the anatomical characteristics and clinical presentation associated with PE after percutaneous coronary intervention (PCI) by using echocardiography. Methods: The clinical outcomes of all patients with coronary artery disease who underwent PCI from July 2014 to December 2018 were evaluated. The quantitative and qualitative analyses of PE were performed. The associations between the presence of PE and procedural factors were also evaluated. Results: A total of 882 patients were enrolled. PE was found in 144 patients (16.3%) and was mostly located in the anterior pericardium at low amounts. The serum levels of high-sensitive C-reaction protein before PCI and troponin T in the group with PE after PCI were significantly higher than those in the group without PE (p < 0.0001). The presence of PE was associated with the procedural time (OR = 1.02, p = 0.035) and the degree of interventional complexity (multiple vessels OR = 1.89, p = 0.014; chronic total occlusion OR = 2.04, p = 0.005; and PCI with rotational atherectomy OR = 1.15, p = 0.011) independent of the number of culprit vessels and stents. During 1-year follow-up, a significantly higher number of cardiac deaths (3) and myocardial infarctions (8) occurred in patients with PE than in patients without PE (P < 0.05). Conclusion: Post-PCI acute PE was frequent, generally mild, mainly asymptomatic, and independently associated with procedural time and complexity. This effusion, which is considered as a cardiac damage marker, could be a predominant clinical sign for long-term prognosis.
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Affiliation(s)
- Bei Zhao
- Department of Cardiology, People's Liberation Army Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Jie Zhang
- Department of Cardiology, People's Liberation Army Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Yun Li
- Outpatient Department, The 22nd Retirement Home for Resigning Cadres in Haidian District, Beijing Garrison of People's Liberation Army, Beijing, China
| | - Xueyao Feng
- Department of Cardiology, People's Liberation Army Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Shuai Mao
- Department of Cardiology, People's Liberation Army Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Zhao Yin
- Department of Cardiology, People's Liberation Army Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Li Liu
- Department of Cardiology, People's Liberation Army Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Dapeng Song
- Department of Cardiology, People's Liberation Army Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Shouli Wang
- Department of Cardiology, People's Liberation Army Strategic Support Force Characteristic Medical Center, Beijing, China
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25
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Armstrong SM, Thavendiranathan P, Butany J. The pericardium and its diseases. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00021-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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26
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PET imaging in cardiovascular infections. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00140-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Hasnie AA, Miller NJ, Davies J, Von Mering G. Constrictive Pericarditis Presenting as Isolated Ascites. Radiol Case Rep 2021; 17:259-264. [PMID: 34849181 PMCID: PMC8609104 DOI: 10.1016/j.radcr.2021.10.047] [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: 08/29/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 11/24/2022] Open
Abstract
Constrictive pericarditis is a rare cause of right-sided heart failure secondary to a stiff, non-compliant pericardium. Clinical presentation can vary considerably and requires a high suspicion for diagnosis. A 31-year-old male presented to the emergency department with complaints of abdominal distension. An abdominal ultrasound revealed large volume ascites; thus, it was initially suspected he had underlying cirrhosis. However, an echocardiogram revealed a diagnosis of constrictive pericarditis. It's important for clinicians to consider constrictive pericarditis in a patient presenting with unexplained right-sided heart failure.
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Affiliation(s)
- Ammar A Hasnie
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Neal J Miller
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - James Davies
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Gregory Von Mering
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233 USA
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Established and Emerging Techniques for Pericardial Imaging with Cardiac Magnetic Resonance. Curr Cardiol Rep 2021; 23:169. [PMID: 34622359 DOI: 10.1007/s11886-021-01595-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Pericardial diseases include a wide range of pathologies and their diagnosis can often be challenging. The goal of this review is to describe the established and emerging CMR imaging techniques used in the assessment of common pericardial diseases and explain the role of pericardial characterization in their diagnosis and management. RECENT FINDINGS CMR is indicated in cases of diagnostic uncertainty and for a comprehensive evaluation of the pericardium and its impact on the heart. This includes assessment of pericardial anatomy and associated cardiac hemodynamics, quantification and characterization of an effusion, disease staging, tissue characterization, guiding management, and even prognostication in some diseases of the pericardium. An emerging technique, pericardial characterization, utilizes various sequences to diagnose and stage pericardial inflammation, act as a biomarker in recurrent pericarditis, and guide management in inflammatory pericardial conditions. Beyond imaging, it has ushered in an era of tailored therapy for patients with pericardial diseases. Future directions should aim at exploring the role of tissue characterization in various pericardial diseases.
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Huang MS, Su YH, Chen JY. Post cardiac injury syndrome successfully treated with medications: a report of two cases. BMC Cardiovasc Disord 2021; 21:394. [PMID: 34391394 PMCID: PMC8364690 DOI: 10.1186/s12872-021-02200-5] [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: 06/17/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background Post cardiac injury syndrome (PCIS) is induced by myocardial infarction or cardiac surgery, as well as minor insults to the heart such as percutaneous coronary intervention (PCI), or insertion of a pacing lead. PCIS is characterized by pericarditis after injury to the heart. The relatively low incidence makes differential diagnosis of PCIS after PCI or implantation of a pacemaker a challenge. This report describes two typical cases of PCIS. Case presentation The first patient presented with signs of progressive cardiac tamponade that occurred two weeks after implantation of a permanent pacemaker. Echocardiography confirmed the presence of a moderate amount of newly-formed pericardial effusion. The second patient underwent PCI for the right coronary artery. However, despite an uneventful procedure, the patient experienced dyspnea, tightness of chest and cold sweats, and bradycardia two hours after the procedure. Echocardiography findings, which showed a moderate amount of newly-formed pericardial effusion, suggested acute cardiac tamponade, and compromised hemodynamics. Both patients recovered with medication. Conclusion These cases illustrated that PCIS can occur after minor myocardial injury, and that the possibility of PCIS should be considered if there is a history of possible cardiac insult.
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Affiliation(s)
- Mu-Shiang Huang
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 704, Taiwan
| | - Yan-Hua Su
- Post Graduate Residency Program, Education Center, Department of Neurosurgery, National Cheng Kung University Hospital, Taipei Veteran General Hospital, Taipei City, Taiwan
| | - Ju-Yi Chen
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 704, Taiwan.
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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: 1] [Impact Index Per Article: 0.3] [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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An overview of human pericardial space and pericardial fluid. Cardiovasc Pathol 2021; 53:107346. [PMID: 34023529 DOI: 10.1016/j.carpath.2021.107346] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/24/2022] Open
Abstract
The pericardium is a double-layered fibro-serous sac that envelops the majority of the surface of the heart as well as the great vessels. Pericardial fluid is also contained within the pericardial space. Together, the pericardium and pericardial fluid contribute to a homeostatic environment that facilitates normal cardiac function. Different diseases and procedural interventions may disrupt this homeostatic space causing an imbalance in the composition of immune mediators or by mechanical stress. Inflammatory cells, cytokines, and chemokines are present in the pericardial space. How these specific mediators contribute to different diseases is the subject of debate and research. With the advent of highly specialized assays that can identify and quantify various mediators we can potentially establish specific and sensitive biomarkers that can be used to differentiate pathologies, and aid clinicians in improving clinical outcomes for patients.
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Rodevič G, Budrys P, Davidavičius G. Acute Pericarditis after Percutaneous Coronary Intervention: A Case Report. ACTA ACUST UNITED AC 2021; 57:medicina57050490. [PMID: 34067941 PMCID: PMC8152033 DOI: 10.3390/medicina57050490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022]
Abstract
Background: Percutaneous coronary intervention (PCI) is known as a very rare possible trigger of pericarditis. Most frequently it develops after a latent period or early in the case of periprocedural complications. In this report, we present an atypical early onset of pericarditis after an uncomplicated PCI. Case Summary: A 58-year-old man was admitted to the hospital for PCI of the chronic total occlusion of the left anterior descending (LAD) artery. An initial electrocardiogram (ECG) was unremarkable. The PCI attempt was unsuccessful. There were no procedure-related complications observed at the end of the PCI attempt and the patient was symptom free. Six hours after the interventional procedure, the patient complained of severe chest pain. The ECG demonstrated ST-segment elevation in anterior and lateral leads. Troponin I was mildly elevated but a coronary angiogram did not reveal the impairment of collateral blood flow to the LAD territory. Due to pericarditic chest pain, typical ECG findings and pericardial effusion with elevated C-reactive protein, the diagnosis of acute pericarditis was established, and a course of nonsteroidal anti-inflammatory drugs (NSAIDs) was initiated. Chest pain was relieved and ST-segment elevation almost completely returned to baseline after three days of treatment. The patient was discharged in stable condition without chest pain on the fourth day after symptom onset. Conclusions: Acute pericarditis is a rare complication of PCI. Despite the lack of specific clinical manifestation, post-traumatic pericarditis should be considered in patients with symptoms and signs of pericarditis and a prior history of iatrogenic injury or thoracic trauma.
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Affiliation(s)
- Greta Rodevič
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21/27, LT-03101 Vilnius, Lithuania;
| | - Povilas Budrys
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Santariškių 2, LT-08661 Vilnius, Lithuania;
- Cardiology and Angiology Center, Vilnius University Hospital Santaros Klinikos, Santariškių 2, LT-08661 Vilnius, Lithuania
- Correspondence:
| | - Giedrius Davidavičius
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Santariškių 2, LT-08661 Vilnius, Lithuania;
- Cardiology and Angiology Center, Vilnius University Hospital Santaros Klinikos, Santariškių 2, LT-08661 Vilnius, Lithuania
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Baik AH, Tsai KK, Oh DY, Aras MA. Mechanisms and clinical manifestations of cardiovascular toxicities associated with immune checkpoint inhibitors. Clin Sci (Lond) 2021; 135:703-724. [PMID: 33686402 PMCID: PMC8647663 DOI: 10.1042/cs20200331] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 12/17/2022]
Abstract
Immunotherapies have greatly expanded the armamentarium of cancer-directed therapies in the past decade, allowing the immune system to recognize and fight cancer. Immune checkpoint inhibitors (ICIs), in particular, have revolutionized cancer treatment and have demonstrated survival benefit in numerous types of cancer. These monoclonal antibodies increase anti-cancer immunity by blocking down-regulators of adaptive immunity, including cytotoxic T lymphocyte-associated protein 4 (CTLA-4), programmed cell death protein 1 (PD-1), and its ligand (PD-L1), resulting in anti-tumor activity. As ICIs increase immune system activation, they can cause a wide range of inflammatory side effects, termed immune-released adverse events. Though these toxicities can affect nearly any organ, the most fatal toxicity is myocarditis. Here, we discuss the diverse spectrum of cardiovascular toxicities associated with ICI use. In addition, we provide insight and future directions on mechanisms and treatments for immune-related adverse events (irAEs) involving the myocardium, pericardium, vasculature, and conduction system.
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Affiliation(s)
- Alan H. Baik
- UCSF Department of Medicine, Division of Cardiology, San Francisco, CA 94143
| | - Katy K. Tsai
- UCSF Department of Medicine, Division of Hematology/Oncology, San Francisco, CA 94143
| | - David Y. Oh
- UCSF Department of Medicine, Division of Hematology/Oncology, San Francisco, CA 94143
| | - Mandar A. Aras
- UCSF Department of Medicine, Division of Cardiology, San Francisco, CA 94143
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Case study-based systematic review of literature on lymphoma-associated cardiac tamponade. Contemp Oncol (Pozn) 2021; 25:57-63. [PMID: 33911983 PMCID: PMC8063898 DOI: 10.5114/wo.2021.103828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/03/2021] [Indexed: 11/17/2022] Open
Abstract
This study aimed to compile all the relevant studies of patients presenting with pericardial tamponade before or after diagnosis of lymphoma, describe the clinical presentations of patients with lymphoma and cardiac tamponade, and assess the difference in overall survival based on the timing of cardiac tamponade diagnosis. A comprehensive search strategy was conducted in the following databases: PubMed and Cochrane Library, using the following keywords: Lymphoma AND Cardiac Tamponade. The criteria for eligibility included cases with a confirmed diagnosis of lymphoma and cardiac tamponade, human studies, and publications in English language. The statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) version 20. We included 48 research articles (n = 52 cases) with adequate reporting of measured outcomes. The median age of the patients was 52 (9–94) years. Only 6 patients were noted to have primary cardiac lymphoma, while the majority of cases were considered to have secondary cardiac lymphoma (88.5%). According to the data on the type of lymphoma reported through cytology and immunohistochemistry, 49 patients were diagnosed with non-Hodgkin lymphoma, and of these cases the most common subtype was large B-cell lymphoma (42.9%). Overall, the average duration of illness was 14 ± 23 days. A total of 13 patients had distant heart sounds, 12 cases were noted to be hypotensive, and 13 subjects were found to have increased jugular venous pressure. Our retrospective study demonstrated that most patients presented with pericardial tamponade after lymphoma diagnosis, and those were mostly secondary cardiac lymphoma of the non-Hodgkin type with large B-cell as the most common subtype. Dyspnoea, oedema, and constitutional symptoms were the most common presenting signs. The median overall survival of patients with lymphoma and cardiac tamponade is 4 months, with no significant difference in mortality in the presentation timing before and after the diagnosis of lymphoma.
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Karima T, Nesrine BZ, Hatem L, Skander BO, Raouf D, Selim C. Constrictive pericarditis: 21 years' experience and review of literature. Pan Afr Med J 2021; 38:141. [PMID: 33912311 PMCID: PMC8052615 DOI: 10.11604/pamj.2021.38.141.22884] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/26/2020] [Indexed: 01/23/2023] Open
Abstract
To the best of our knowledge there are no publications about Tunisian experience in constrictive pericarditis (CP); the aim of this study was therefore to review our twenty-one years’ experience in terms of clinical and surgical outcomes and risk factors of death after pericardiectomy. An analytic bicentric and retrospective study carried out on 25 patients (20 male) with CP underwent pericardiectomy, collected over a 21-years period. The mean age was 40.46±16.74 years [7.5-72]. The commonest comorbid factor was tabagism (52%). The most common etiology was tuberculosis (n = 11, 44%). Dyspnea was the most common functional symptom (n = 21, 84%). Pericardiectomy was performed in all our patients within 2.9±3.19 months after confirmation of diagnosis. It was subtotal in 96% of cases. The commonest postoperative complications are pleural effusion (20%). Dyspnea was regressed within 1.8 months in 80% of cases and clinical signs of right heart failure within a mean duration of 1.62 months in 53% of cases. Perioperative mortality was 12% (3 deaths), late mortality was 4% (1 patient). Cardiopulmonary bypass, New York Heart Association (NYHA) over class II and right ventricular dysfunction are the prognostic factors of mortality (p = 0.001, 0.046, 0.019). Tuberculosis as etiology of CP had no impact on mortality. CP is a rare disease, with non-specific clinical signs. Pericardiectomy is effective with a significant improvement of the functional status of patients and favorable outcome at short and long term nevertheless hospital mortality is not negligible and depends on many factors.
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Affiliation(s)
- Taamallah Karima
- Department of Cardiac Surgery, Military Hospital of Tunis, Tunis, Tunisia
| | - Ben Zaied Nesrine
- Department of Cardiac Surgery, Military Hospital of Tunis, Tunis, Tunisia
| | - Lahdhili Hatem
- Department of Cardiac Surgery, Military Hospital of Tunis, Tunis, Tunisia
| | | | - Denguir Raouf
- Department of Cardiac Surgery, La Rabta Hospital, Tunis, Tunisia
| | - Chenik Selim
- Department of Cardiac Surgery, Military Hospital of Tunis, Tunis, Tunisia
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Salarda EM, Ocazionez-Trujillo D, Prakash SK. An unusual cause of acute pericarditis: a case report. Eur Heart J Case Rep 2021; 5:ytaa535. [PMID: 33738403 PMCID: PMC7954249 DOI: 10.1093/ehjcr/ytaa535] [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: 06/18/2020] [Revised: 07/21/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Inflammation of the pericardium, or pericarditis, is a frequent cause of acute chest pain in young patients. Pericarditis is typically associated with viral infections, but other potential causes may have distinct prognostic and therapeutic implications. CASE SUMMARY A 26-year-old man presented with typical signs and symptoms of acute pericarditis. However, imaging disclosed an anterior mediastinal mass that compressed the right ventricular outflow tract. The coarse outflow murmur convincingly mimicked a pericardial friction rub on auscultation. CONCLUSION Clinicians should be aware of alternative aetiologies to pericarditis in patients who present with prolonged or refractory symptoms.
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Affiliation(s)
- Erika M Salarda
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 6.106, Houston, TX 77030, USA
| | - Daniel Ocazionez-Trujillo
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 6.106, Houston, TX 77030, USA
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Malgope R, Basu S, Sinha MK. Clinico-Etiological Profile of Children with Pericardial Effusion in a Tertiary Care Hospital in Eastern India. J Trop Pediatr 2021; 67:6042807. [PMID: 33346812 DOI: 10.1093/tropej/fmaa118] [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: 11/14/2022]
Abstract
INTRODUCTION Pericardial effusion may be due to various causes. With the changing scenario of newer generation antibiotics and robust immunization program our aim is to identify the change, if any, in etiology and disease menifestations. METHODOLOGY This is a hospital-based uni-center prospective study with a population of 30 children for a period of 1½ year. Clinico-epidemiological features, investigations, complications and short-term outcome were assessed. RESULTS We found 13 (43.33%) patients having mild, 11 (36.67%) had moderate and 6 (20%) had severe pericardial effusion. Cardiac tamponade was present in six cases. Among the study population 9 (30%) patients were diagnosed as having pyogenic pericardial effusion and 8 (26.67%) had tubercular effusion. The predominant symptoms of pericardial effusion in our children were fever and tachycardia (83.33%).Other symptoms at presentation were tachycardia (76.67%), cough (63.33%), chest pain (50%), orthopnea (43.33%) and skin rash (16.67%). Pericardiocentesis was done in 14 cases (46.67%) of which 4 patients (13.33%) required pig tail catheterization. DISCUSSION Infectious etiology still remains the primary cause of pericardial effusion in our country. The presenting clinical signs are very much nonspecific and also not so prominent unless hemodynamic compromisation occurs. CONCLUSION This study showed that bacterial and tubercular pericardial effusions are still two most prevalent etiological diagnosis in this part of country. Early diagnosis and treatment has good outcome.
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Affiliation(s)
| | - Suprit Basu
- Department of Pediatrics, Institute of Postgraduate Medical Education & Research, Kolkata 700061, India
| | - Malay Kumar Sinha
- Department of Pediatrics, Institute of Postgraduate Medical Education & Research, Kolkata 700061, India
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Huang L, Zhou Q, Cui X, Hu X, Duan D, Wu P, Gao W, Ning M, Li T. Diagnosis and etiological identification in severe constrictive pericarditis in a 14-year-old girl: a case report. Transl Pediatr 2021; 10:209-214. [PMID: 33633955 PMCID: PMC7882285 DOI: 10.21037/tp-20-203] [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] [Indexed: 11/06/2022] Open
Abstract
Constrictive pericarditis in children is exceedingly rare, and may cause very problematic confusion of diagnosis and etiology identification. In this case, we examined a 14-year-old female patient who had developed signs of significant anasarca which was eventually turned out to be constrictive pericarditis. Affected by the experience of examiners, the patient was not diagnosed or even suspected with constrictive pericarditis when she was initially examined by echocardiography in the hospital where she visited before. Reexamination of echocardiography, cardiac catheterization and non-invasive image techniques were performed to establish the diagnosis finally. Open pericardectomy was ultimately performed and normal hemodynamic parameters and cardiac function were obtained postoperatively. In the determination of etiology, we inferred that chronic infection induced by local virus infection in the pericardium led to constrictive pericarditis. Parvovirus B19 (PVB19) and/or human herpes virus 6 (HHV-6) were the two most likely viruses involved based on published literature reviews. Importantly, we learned that serological antibody testing may be false-negative and polymerase chain reaction (PCR) or metagenomic next-generation sequencing for pericardial viral nucleic acid testing may be the gold standard for confirmation. Unfortunately, fresh pericardial tissue samples were not taken before paraformaldehyde fixation in our case, which made it impossible for us to detect suspicious viruses. We do hope that the lessons learned from this case will be helpful and instructive for the etiological diagnosis of similar patients in the future.
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Affiliation(s)
- Lei Huang
- Department of Heart Center, Tianjin Third Central Hospital, Tianjin, China.,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
| | - Quan Zhou
- Department of Heart Center, Tianjin Third Central Hospital, Tianjin, China.,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
| | - Xiaoqiong Cui
- Department of Heart Center, Tianjin Third Central Hospital, Tianjin, China.,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
| | - Xiaomin Hu
- Department of Heart Center, Tianjin Third Central Hospital, Tianjin, China.,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
| | - Dawei Duan
- Department of Heart Center, Tianjin Third Central Hospital, Tianjin, China.,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
| | - Peng Wu
- Department of Heart Center, Tianjin Third Central Hospital, Tianjin, China.,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
| | - Wenqing Gao
- Department of Heart Center, Tianjin Third Central Hospital, Tianjin, China.,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
| | - Meng Ning
- Department of Heart Center, Tianjin Third Central Hospital, Tianjin, China.,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
| | - Tong Li
- Department of Heart Center, Tianjin Third Central Hospital, Tianjin, China.,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
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Bouriche F, Toro A, Negre V, Yvorra S. Acute Pericarditis: Aetiologic Diagnosis and Practical Aspect of the Management. Curr Probl Cardiol 2020; 46:100769. [PMID: 33412346 DOI: 10.1016/j.cpcardiol.2020.100769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
Pericarditis is an uncommon pathology that represents 0.1% of patients hospitalized for chest pain with a wide etiological spectrum and whose cause is uncommonly highlighted. In order to determine the incidence of specific acute microbiological or autoimmune pericarditis and identify subsets of patients with a higher incidence of specific etiologies; and analyze the conformity of the management of acute pericarditis according to the recommendations, a retrospective inclusion of all patients admitted to our hospital from January 2010 to December 2018 with the diagnosis of acute pericarditis was conducted. Data concerning clinical, paraclinical and treatment items were collected. Ninety-nine patients were included. Specific etiologic exams were completely conducted in 63.6% of the patients. There was no link between the decision to conduct etiology exams and the age, gender, a history of acute pericarditis or relapse. There was a trend between an elevated CRP and the realization of the kit. There was a statistically significant link between the achievement of etiologic exams and the presence of severity criteria or the presence of a pericardial effusion. An etiology was found in 52.4%, more frequently microbiological (viral and Mycoplasma pneumoniae). Approximately 85.9% of all patients were hospitalized. Treatment was in accordance with the recommendations in 76.8%. Despite the percentage of microbiological etiologies found, it does not impact the therapeutic strategy. The criteria for hospitalization must be better suited since half of those hospitalized after the european society of cardiology (ESC) 2015 recommendations had no need to be. However, monitoring after discharge is not clearly defined by learned societies.
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Affiliation(s)
| | | | | | - Serge Yvorra
- Centre Hospitalier de Martigues, Martigues, France
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40
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Scoglio M, Vivekanantham H, Arroyo D. Postcardiotomy effusive-constrictive pericarditis in a 65-year-old man: Noteworthy echocardiographic signs. Echocardiography 2020; 37:2116-2122. [PMID: 33179802 DOI: 10.1111/echo.14926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/16/2020] [Accepted: 10/26/2020] [Indexed: 11/26/2022] Open
Abstract
Effusive-constrictive pericarditis (eCP) is a rare entity where constriction of the heart occurs through the visceral pericardium, with concomitant presence of a tense effusion in the pericardial space. We present the case of a 65-year-old patient with shortness of breath and pericardial effusion, 4 months after aortic and mitral valve replacement for Streptococcus agalactiae endocarditis. The present report focuses on the echocardiographic features of constrictive pericarditis (CP) and provides a brief overview of the pathophysiology, work-up, and management guidelines.
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Affiliation(s)
- Martin Scoglio
- Department of Cardiology, University and Hospital of Fribourg, Fribourg, Switzerland
| | - Hari Vivekanantham
- Department of Cardiology, University and Hospital of Fribourg, Fribourg, Switzerland
| | - Diego Arroyo
- Department of Cardiology, University and Hospital of Fribourg, Fribourg, Switzerland
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An easily dismissed suspect of heart failure. COR ET VASA 2020. [DOI: 10.33678/cor.2020.057] [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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Al-Mohammad A, Partridge DG, Fent G, Watson O, Lewis NT, Storey RF, Makris M, Chico TJ. The cardiac complications of COVID-19: many publications, multiple uncertainties. VASCULAR BIOLOGY (BRISTOL, ENGLAND) 2020; 2:R105-R114. [PMID: 33283157 PMCID: PMC7709917 DOI: 10.1530/vb-20-0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/20/2020] [Indexed: 12/16/2022]
Abstract
Since the first description of COVID-19 in December 2019, more than 63,000 publications have described its virology, clinical course, management, treatment and prevention. Most physicians are now encountering, or will soon encounter, patients with COVID-19 and must attempt to simultaneously assimilate this avalanche of information while managing an entirely novel disease with few guiding precedents. It is increasingly clear that, although primarily a respiratory illness, COVID-19 is associated with cardiovascular complications. However, the true incidence of direct cardiac complications remains unclear, as all complications thus far reported can also occur in patients without COVID-19. In this review, we briefly summarise and critically appraise the data on cardiac complications associated with COVID-19 and describe some cases from our own experience. We identify unresolved questions and highlight the many uncertainties in this developing field.
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Affiliation(s)
- Abdallah Al-Mohammad
- Department of Infection, Immunity and Cardiovascular Diseases, University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - David G Partridge
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Florey Institute for Host Pathogen Research, University of Sheffield, Sheffield, UK
| | - Graham Fent
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Oliver Watson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Nigel T Lewis
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Diseases, University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Michael Makris
- Department of Infection, Immunity and Cardiovascular Diseases, University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Timothy J Chico
- Department of Infection, Immunity and Cardiovascular Diseases, University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Abstract
BACKGROUND Constrictive pericarditis is a rare, but increasingly recognized long-term postoperative complication of lung transplantation. Heightened clinical suspicion, improved diagnostic imaging, and effective surgical treatment of the disease have led to progressive awareness of the pathology. We present our institutional experience with constrictive pericarditis after lung transplant in an effort to investigate the cause and natural history of the disease. METHODS From October 2005 to October 2018, 1234 patients underwent orthotopic lung transplantation at Duke University Hospital. An institutional database was queried to identify incident patients and determine baseline clinical data. At a median of 11.2 months (interquartile range = 4.6-28.6 mo), 10 patients (0.8%) developed constrictive pericarditis. Simple descriptive statistics were used to describe cohort characteristics and identify variables associated with constrictive pericarditis after lung transplantation. RESULTS The indication for transplantation at index operation was idiopathic pulmonary fibrosis in 8 of 10 patients (1.2% of the 760 restrictive lung disease patients transplanted in the same time period). All 10 patients presented with worsening dyspnea and pleural effusions. Right heart catheterization confirmed constrictive physiology in all cases. Eight patients underwent pericardiectomy with improvement in cardiovascular hemodynamics and resolution of symptoms with no 30-day mortality. CONCLUSIONS Diagnosis of constrictive pericarditis should be considered in patients with new-onset heart failure symptoms or recurrent pleural effusions within 2 years of lung transplantation. Idiopathic pulmonary fibrosis may be associated with increased risk for constrictive pericarditis. Pericardiectomy is a safe and effective treatment for posttransplant constrictive pericarditis.
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Ecografía clínica en la valoración de pericarditis aguda. Semergen 2020; 46:426-427. [DOI: 10.1016/j.semerg.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 02/12/2020] [Accepted: 02/20/2020] [Indexed: 11/20/2022]
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Verma BR, Montane B, Chetrit M, Khayata M, Furqan MM, Ayoub C, Klein AL. Pericarditis and Post-cardiac Injury Syndrome as a Sequelae of Acute Myocardial Infarction. Curr Cardiol Rep 2020; 22:127. [PMID: 32856192 DOI: 10.1007/s11886-020-01371-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Pericarditis secondary to acute myocardial infarction (AMI) is known to develop either immediately or after a latent period of few months. Due to varied presentation and timing, its diagnosis and treatment can be challenging. This article reviews underlying mechanisms and the role of cardiac imaging in investigating and managing this condition. RECENT FINDINGS Timely diagnosis of pericarditis after AMI is important to prevent potential progression to complicated pericarditis. Clinical suspicion warrants initial investigation with serum inflammatory levels, electrocardiogram, and echocardiography. When findings are inconclusive, cardiac magnetic resonance imaging and computerized tomography can provide additional diagnostic information. Pericarditis after AMI is a treatable condition. Clinicians should maintain a high suspicion in this era of revascularization and develop a strategic plan for timely diagnosis and management.
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Affiliation(s)
- Beni R Verma
- Department of Cardiovascular Medicine and Department of Thoracic and Cardiovascular Surgery Cleveland Clinic, Center for Diagnosis and Treatment of Pericardial Disease, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, USA
| | - Bryce Montane
- Department of Cardiovascular Medicine and Department of Thoracic and Cardiovascular Surgery Cleveland Clinic, Center for Diagnosis and Treatment of Pericardial Disease, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, USA
| | - Michael Chetrit
- Department of Cardiovascular Medicine and Department of Thoracic and Cardiovascular Surgery Cleveland Clinic, Center for Diagnosis and Treatment of Pericardial Disease, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, USA
| | - Mohamed Khayata
- Department of Cardiovascular Medicine and Department of Thoracic and Cardiovascular Surgery Cleveland Clinic, Center for Diagnosis and Treatment of Pericardial Disease, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, USA
| | - Muhammad M Furqan
- Department of Cardiovascular Medicine and Department of Thoracic and Cardiovascular Surgery Cleveland Clinic, Center for Diagnosis and Treatment of Pericardial Disease, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, USA
| | - Chadi Ayoub
- Department of Cardiovascular Medicine and Department of Thoracic and Cardiovascular Surgery Cleveland Clinic, Center for Diagnosis and Treatment of Pericardial Disease, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, USA
| | - Allan L Klein
- Department of Cardiovascular Medicine and Department of Thoracic and Cardiovascular Surgery Cleveland Clinic, Center for Diagnosis and Treatment of Pericardial Disease, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, USA.
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Qian J, Xie J, Lakshmipriya T, Gopinath SCB, Xu H. Heart Infection Prognosis Analysis by Two-dimensional Spot Tracking Imaging. Curr Med Imaging 2020; 16:534-544. [PMID: 32484087 DOI: 10.2174/1573405615666190130164037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/19/2018] [Accepted: 01/04/2019] [Indexed: 11/22/2022]
Abstract
Cardiovascular death is one of the leading causes worldwide; an accurate identification followed by diagnosing the cardiovascular disease increases the chance of a better recovery. Among different demonstrated strategies, imaging on cardiac infections yields a visible result and highly reliable compared to other analytical methods. Two-dimensional spot tracking imaging is the emerging new technology that has been used to study the function and structure of the heart and test the deformation and movement of the myocardium. Particularly, it helps to capture the images of each segment in different directions of myocardial strain values, such as valves of radial strain, longitudinal strain, and circumferential strain. In this overview, we discussed the imaging of infections in the heart by using the two-dimensional spot tracking.
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Affiliation(s)
- Jie Qian
- Department of ICU, Shuyang Hospital of Traditional Chinese Medicine, Shuyang, Suqian, Jiangsu 223600, China
| | - Jing Xie
- Department of ICU, Shuyang Hospital of Traditional Chinese Medicine, Shuyang, Suqian, Jiangsu 223600, China
| | - Thangavel Lakshmipriya
- Institute of Nano Electronic Engineering, Universiti Malaysia Perlis, Kangar 01000, Perlis, Malaysia
| | - Subash C B Gopinath
- Institute of Nano Electronic Engineering, Universiti Malaysia Perlis, Kangar 01000, Perlis, Malaysia.,School of Bioprocess Engineering, Universiti Malaysia Perlis, Arau 02600, Perlis, Malaysia
| | - Huaigang Xu
- Department of ICU, Shuyang Hospital of Traditional Chinese Medicine, Shuyang, Suqian, Jiangsu 223600, China
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Helwani MA, Alber S, DeWet CJ, Zoller JK. Intraoperative Assessment of Hepatic Vein Tracings in Constrictive Pericarditis During Surgical Pericardiectomy. J Cardiothorac Vasc Anesth 2020; 34:1099-1102. [DOI: 10.1053/j.jvca.2019.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/04/2019] [Accepted: 11/09/2019] [Indexed: 11/11/2022]
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Lasrado N, Yalaka B, Reddy J. Triggers of Inflammatory Heart Disease. Front Cell Dev Biol 2020; 8:192. [PMID: 32266270 PMCID: PMC7105865 DOI: 10.3389/fcell.2020.00192] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/06/2020] [Indexed: 12/14/2022] Open
Abstract
Inflammatory heart disease (IHD) is a group of diseases that includes pericarditis, myocarditis, and endocarditis. Although males appear to be more commonly affected than females, IHD can be seen in any age group. While the disease can be self-limiting leading to full recovery, affected individuals can develop chronic disease, suggesting that identification of primary triggers is critical for successful therapies. Adding to this complexity, however, is the fact that IHD can be triggered by a variety of infectious and non-infectious causes that can also occur as secondary events to primary insults. In this review, we discuss the immunological insights into the development of IHD as well as a mechanistic understanding of the disease process in animal models.
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Affiliation(s)
- Ninaad Lasrado
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska–Lincoln, Lincoln, NE, United States
| | - Bharathi Yalaka
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska–Lincoln, Lincoln, NE, United States
- Bristol-Myers Squibb – Hopewell, Pennington, NJ, United States
| | - Jay Reddy
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska–Lincoln, Lincoln, NE, United States
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Surgical rescues for critical hemopericardium complicated by acute type A aortic dissection: Emergent subxiphoid pericardiotomy or cardiopulmonary bypass first? PLoS One 2020; 15:e0229648. [PMID: 32119707 PMCID: PMC7051057 DOI: 10.1371/journal.pone.0229648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 02/11/2020] [Indexed: 12/31/2022] Open
Abstract
Background Hemopericardium is a common and hazardous complication of acute type A aortic dissection (ATAAD). This retrospective study aimed to clarify the short-term and mid-term outcomes in patients who underwent surgical rescues for hemopericardium complicated by ATAAD. Methods Between January 2007 and March 2019, 586 consecutive patients underwent ATAAD repair at our institution. According to preoperative computed tomography, hemopericardium was found in 191 patients (32.6%), 150 were stabilized with medical treatment, and 41 underwent surgical rescues for critical hemodynamics. The 41 patients were classified into groups according to their rescue procedures: emergent subxiphoid pericardiotomy (E-SXP group, n = 26, 63.4%) or emergent cardiopulmonary bypass (E-CPB group, n = 15, 36.6%). Clinical features, surgical information, postoperative complications, and 3-year survival were analyzed and compared. Results Demographics, comorbidities and aortic repair procedures were generally homogenous between the two groups, except for sex. The average systolic blood pressure was 62.4 ± 13.3 mmHg and 67.1 ± 13.1 mmHg in the E-SXP and E-CPB groups, respectively. A total of 29.3% of patients underwent cardiopulmonary resuscitation (CPR) before surgical rescues. The in-hospital mortality was similar (30.8% versus 33.3%, P = 0.865) in the two groups. Multivariate analysis revealed that preoperative CPR was an in-hospital predictor of mortality. For patients who survived to discharge, 3-year cumulative survival rates were 87.8% ± 8.1% and 60.0% ± 19.7% in the E-SXP and E-CPB groups, respectively (P = 0.170). Conclusions Patients who underwent surgical rescues for ATAAD-complicated hemopericardium are at a high risk of in-hospital mortality. The two rescue procedures revealed similar short-term and mid-term outcomes.
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