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Sohal S, Mathai SV, Lipat K, Kaur A, Visveswaran G, Cohen M, Waxman S, Tiwari N, Vucic E. Multimodality Imaging of Constrictive Pericarditis: Pathophysiology and New Concepts. Curr Cardiol Rep 2022; 24:1439-1453. [PMID: 35917048 PMCID: PMC9344806 DOI: 10.1007/s11886-022-01758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/15/2022]
Abstract
Purpose of Review The unique pathophysiological changes of constrictive pericarditis (CP) can now be identified with better imaging modalities, thereby helping in its early diagnosis. Through this review, we outline the pathophysiology of CP and its translation into symptomology and various imaging findings which then are used for both diagnosis and guiding treatment options for CP. Recent Findings Multimodality imaging has provided us with the capability to recognize early stages of the disease and identify patients with a potential for reversibility and can be treated with medical management. Additionally, peri-procedural planning and prediction of post-operative complications has been made possible with the use of advanced imaging techniques. Summary Advanced imaging has the potential to play a greater role in identification of patients with reversible disease process and provide peri-procedural risk stratification, thereby improving outcomes for patients with CP.
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Affiliation(s)
- Sumit Sohal
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA.
| | - Sheetal Vasundara Mathai
- Division of Cardiovascular Diseases, Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Kevin Lipat
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Arpanjeet Kaur
- Department of Medicine, Mount Sinai West, 1000 Tenth Avenue, New York, NY, 10019, USA
| | - Gautam Visveswaran
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Marc Cohen
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Sergio Waxman
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Nidhish Tiwari
- Division of Cardiovascular Diseases, Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Esad Vucic
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
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Yang JH, Miranda WR, Nishimura RA, Greason KL, Schaff HV, Oh JK. Prognostic importance of mitral e' velocity in constrictive pericarditis. Eur Heart J Cardiovasc Imaging 2021; 22:357-364. [PMID: 32514577 DOI: 10.1093/ehjci/jeaa133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS Increased medial mitral annulus early diastolic velocity (e') plays an important role in the echocardiographic diagnosis of constrictive pericarditis (CP) and mitral e' velocity is also a marker of underlying myocardial disease. We assessed the prognostic implication of mitral e' for long-term mortality after pericardiectomy in patients with CP. METHODS AND RESULTS We studied 104 surgically confirmed CP patients who underwent echocardiography and cardiac catheterization within 7 days between 2005 and 2013. Patients were classified as primary CP (n = 45) or mixed CP (n = 59) based on the clinical history of concomitant myocardial disease. On multivariable analysis, medial e' velocity and mean pulmonary artery pressure were independently associated with long-term mortality post-pericardiectomy. There were significant differences in survival rates among the groups divided by cut-off values of 9.0 cm/s and 29 mmHg for medial e' and mean pulmonary artery pressure, respectively (both P < 0.001). Ninety-two patients (88.5%) had elevated pulmonary artery wedge pressure (PAWP) (≥15 mmHg); there was no significant correlation between medial E/e' and PAWP (r = 0.002, P = 0.998). However, despite the similar PAWP between primary CP and mixed CP groups (21.6 ± 5.4 vs. 21.2 ± 5.8, P = 0.774), all primary CP individuals with elevated PAWP had medial E/e' <15 as opposed to 34 patients (57.6%) in the mixed CP group (P < 0.001). CONCLUSION Increased mitral e' velocity is associated with better outcomes in patients with CP. A paradoxical distribution of the relationship between E/e' and PAWP is present in these patients but there is no direct inverse correlation between them.
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Affiliation(s)
- Jeong Hoon Yang
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.,Division of Cardiology, Department of Critical Care Medicine and Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.,Division of Cardiology, Department of Critical Care Medicine and Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
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Lim K, Yang JH, Miranda WR, Chang SA, Jeong DS, Nishimura RA, Schaff H, Soo WM, Greason KL, Oh JK. Clinical significance of pulmonary hypertension in patients with constrictive pericarditis. Heart 2021; 107:1651-1656. [PMID: 34285103 DOI: 10.1136/heartjnl-2021-319149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/08/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We investigated haemodynamics and clinical outcomes according to type of pulmonary hypertension (PH) in patients with constrictive pericarditis (CP). BACKGROUND As the prevalence of CP with concomitant myocardial disease (mixed CP) grows, PH is more commonly seen in patients with CP. However, haemodynamic and outcome data according to the presence or absence of PH are limited. METHODS 150 patients with surgically confirmed CP who underwent echocardiography and cardiac catheterisation within 7 days at two tertiary centres were divided into three groups: no-PH, isolated postcapillary PH (Ipc-PH) and combined postcapillary and precapillary PH (Cpc-PH). Primary outcome was all-cause mortality during follow-up. RESULT In this retrospective cohort study, 110 (73.3%) had PH (mean pulmonary artery pressure ≥25 mm Hg). Cpc-PH, using defined cut-offs for pulmonary vascular resistance (>3 Wood units) or diastolic pulmonary gradient (≥7 mm Hg), was seen in 18 patients (12%). The Cpc-PH group had a higher prevalence of comorbidities (diabetes and atrial fibrillation) and concomitant myocardial disease as an aetiology of CP than other groups. Pulmonary vascular resistance had a significant direct correlation with medial E/e' by Doppler echocardiography (r=0.404, p<0.001). Survival rate was significantly lower in the Cpc-PH than the no-PH (p=0.002) and Ipc-PH (p=0.024) groups. On multivariable analysis, age, New York Heart Association functional class IV, medial e' velocity, Cpc-PH and Ipc-PH were independently associated with long-term mortality. CONCLUSION Combined postcapillary and precapillary PH develops in a subset of patients with CP and is associated with long-term mortality after pericardiectomy.
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Affiliation(s)
- Kyunghee Lim
- Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea (the Republic of)
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of).,Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the republoic of)
| | - William R Miranda
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul, Korea (the Republic of)
| | - Rick A Nishimura
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Hartzell Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Wern Miin Soo
- Department of Cardiology, National University Hospital, Singapore
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jae K Oh
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of).,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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Li L, Deng YB, Guo LD, Liu K, Zhang J, Tang QY. Evaluation of Long-Term Impact of Pericardiectomy on Left Atrial Functions in Patients with Constrictive Pericarditis Using Speckle Tracking Echocardiography. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1158-1168. [PMID: 32107091 DOI: 10.1016/j.ultrasmedbio.2020.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/03/2020] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
The aims of this study were to explore the long-term impact of pericardiectomy on left atrial (LA) functions in patients with constrictive pericarditis (CP) using speckle tracking echocardiography (STE) and to correlate post-operative LA functions with clinical status. Echocardiographic examinations were undertaken in 29 patients with CP 1 wk before and 1, 6 and 12 mo after pericardiectomy. STE was performed to obtain LA global longitudinal strain, including strain during the conduit phase (LAScd), strain during the contraction phase (LASct) the sum of the latter and strain during the reservoir phase (LASr). Control patients consisted of 29 age- and sex-matched healthy volunteers. LASct, LAScd and LASr obtained 6 mo after pericardiectomy improved significantly compared with pre-operative values, but were still lower than the values for control patients. Further increases were observed gradually with normalization of LASct 12 mo after pericardiectomy. However, there were still significant differences between LAScd and LASr obtained in control patients and those obtained 12 mo after pericardiectomy. Moreover, the improvements in LAScd, LASct and LASr 12 mo after pericardiectomy correlated well with symptomatic clinical alleviation (p < 0.01). These results indicate that LA strains analyzed with STE might be useful in evaluating the long-term impact of pericardiectomy on LA functions.
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Affiliation(s)
- Li Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - You-Bin Deng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Ling-Dan Guo
- Department of Medical Ultrasound, Wuhan Center Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun Liu
- Department of Medical Ultrasound, Third People's Hospital of Hubei Province, Wuhan, China
| | - Jun Zhang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiao-Ying Tang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Constrictive Pericarditis: Differentiating the "Purebred" From the "Mixed Bag". J Am Coll Cardiol 2019; 73:3322-3325. [PMID: 31248554 DOI: 10.1016/j.jacc.2019.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/06/2019] [Indexed: 11/22/2022]
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Alajaji W, Xu B, Sripariwuth A, Menon V, Kumar A, Schleicher M, Isma’eel H, Cremer PC, Bolen MA, Klein AL. Noninvasive Multimodality Imaging for the Diagnosis of Constrictive Pericarditis. Circ Cardiovasc Imaging 2018; 11:e007878. [DOI: 10.1161/circimaging.118.007878] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Wissam Alajaji
- Department of Cardiovascular Medicine, Summa Health Heart and Vascular Institute, Akron, OH (W.A.)
| | - Bo Xu
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
| | | | - Vivek Menon
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
| | - Arnav Kumar
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
| | - Mary Schleicher
- Cleveland Clinic Alumni Library (M.S.), Cleveland Clinic, OH
| | | | - Paul C. Cremer
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
| | - Michael A. Bolen
- Cardiovascular Section, Imaging Institute (A.S., M.A.B.), Cleveland Clinic, OH
| | - Allan L. Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
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Ardhanari S, Yarlagadda B, Parikh V, Dellsperger KC, Chockalingam A, Balla S, Kumar S. Systematic review of non-invasive cardiovascular imaging in the diagnosis of constrictive pericarditis. Indian Heart J 2016; 69:57-67. [PMID: 28228308 PMCID: PMC5318986 DOI: 10.1016/j.ihj.2016.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 05/26/2016] [Accepted: 06/08/2016] [Indexed: 11/10/2022] Open
Abstract
Background Diagnosis of constrictive pericarditis (CP) can be challenging. It can be nearly impossible to distinguish CP from other causes of right heart failure. Although various imaging modalities help in the diagnosis, no test is definitive. Several reviews have addressed the role of various imaging techniques in the diagnosis of CP but a systematic review has not yet been published. Objective Our intention was to study the ability of various non-invasive imaging modalities to diagnose CP in patients with surgically confirmed disease and to apply our findings to develop a clinically useful diagnostic algorithm. Methods A PubMed (NLM) search was performed with MeSH term “constrictive pericarditis”. Original articles that investigated the ability of various cardiovascular imaging modalities to noninvasively diagnose surgically confirmed CP were included in our review. Investigations that included any cases without surgical confirmation were excluded. Results The PubMed search yielded 3001 results with MeSH term “constrictive pericarditis” (January 8, 2016). We identified (40) studies on CP that matched our inclusion criteria. We summarized our results sorted by individual non-invasive CV imaging modalities – echocardiography, cardiac computed tomography (CT), and magnetic resonance imaging (MRI). Under each imaging modality, we grouped our discussion based on different parameters useful in CP diagnosis. Conclusions In conclusion, contemporary diagnosis of CP is based on clinical features and echocardiography. Cardiac MRI is recommended in patients where echocardiography is not diagnostic. Both cardiac MRI and CT can guide surgical planning but we prefer MRI as it provides both structural and functional information.
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Affiliation(s)
- Sivakumar Ardhanari
- Department of Medicine, Division of Cardiology, University of Missouri School of Medicine, Columbia, MO, United States
| | - Bharath Yarlagadda
- Department of Medicine, Division of Cardiology, University of Missouri School of Medicine, Columbia, MO, United States
| | - Vishal Parikh
- Department of Cardiology, University of South Florida, Tampa, FL, United States
| | - Kevin C Dellsperger
- Department of Medicine, Augusta University Health, Augusta, GA, United States
| | - Anand Chockalingam
- Department of Medicine, Division of Cardiology, University of Missouri School of Medicine, Columbia, MO, United States
| | - Sudarshan Balla
- Department of Medicine, Division of Cardiology, University of Missouri School of Medicine, Columbia, MO, United States
| | - Senthil Kumar
- Department of Medicine, Division of Cardiology, University of Missouri School of Medicine, Columbia, MO, United States.
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Hayashi T, Yamada S, Iwano H, Nakabachi M, Sakakibara M, Okada K, Murai D, Nishino H, Kusunose K, Watanabe K, Ishizu T, Wakami K, Yamada H, Dohi K, Seo Y, Ohte N, Mikami T, Tsutsui H. Left Ventricular Global Strain for Estimating Relaxation and Filling Pressure - A Multicenter Study. Circ J 2016; 80:1163-70. [PMID: 27021934 DOI: 10.1253/circj.cj-16-0106] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Speckle-tracking echocardiography (STE)-derived parameters may have better correlation with left ventricular (LV) relaxation and filling pressure than tissue Doppler-derived parameters. However, it has not been elucidated which parameter - strain or strain rate - and which direction of myocardial deformation - longitudinal or circumferential - is the most useful marker of LV relaxation and filling pressure. METHODS AND RESULTS We conducted a prospective multicenter study and compared the correlation of tissue Doppler- and STE-derived parameters with the time constant of LV pressure decay (τ) and LV mean diastolic pressure (MDP) in 77 patients. The correlation of early-diastolic mitral annular velocity (e´) with τ was weak (r=-0.32, P<0.01), and that of peak longitudinal strain (LS) was the strongest (r=-0.45, P<0.001) among the STE-derived parameters. There was a modest correlation between LVMDP and the ratio of early-diastolic inflow velocity (E) to e´ (E/e´) (r=0.50, P<0.001). In contrast, the ratio of E to LS (E/LS) correlated strongly with LVMDP (r=0.70, P<0.001). The correlation of E/LS with LVMDP was significantly better than that for E/e´ (P<0.01). Receiver-operating characteristic analysis showed that E/LS had the largest area under the curve for distinguishing elevated LVMDP (E/LS 0.86, E/e´ 0.74, E/A 0.67). CONCLUSIONS STE-derived longitudinal parameters correlated well with LV relaxation and filling pressure. In particular, E/LS could be more accurate than E/e´ for estimating LV filling pressure. (Circ J 2016; 80: 1163-1170).
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Affiliation(s)
- Taichi Hayashi
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
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Li L, Deng YB, Liu K, Guo LD, Liu HY, Zhou W, Tang QY. Long-Term Effects of Pericardiectomy on Left Ventricular Mechanics Evaluated by Using Speckle Tracking Echocardiography in Patients with Constrictive Pericarditis. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:421-429. [PMID: 26653938 DOI: 10.1016/j.ultrasmedbio.2015.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 09/21/2015] [Accepted: 10/29/2015] [Indexed: 06/05/2023]
Abstract
The aim of this study was to evaluate long-term changes in left ventricular (LV) mechanics after pericardiectomy in patients with constrictive pericarditis (CP) and to correlate post-operative LV mechanics with clinical status. A total of 24 patients with CP underwent serial speckle tracking echocardiography 1 wk before and 1, 6 and 12 mo after pericardiectomy. Global LV longitudinal, circumferential and radial strains, along with LV twist, were measured. Twenty-three healthy volunteers were served as control patients. Although global LV longitudinal, circumferential and radial strains obtained 6 mo after pericardiectomy increased compared with those for pre-pericardiectomy, they were still significantly lower than those for control patients. Further improvements occurred over time with normalization of global LV longitudinal and radial strains 12 mo after pericardiectomy, but global circumferential strain obtained 12 mo after pericardiectomy was still lower than that for control patients. LV twist remained unchanged after pericardiectomy. In addition, the improvements in global LV circumferential strain after pericardiectomy were associated with improvements in clinical symptoms (p < 0.001). These findings suggest that the global LV circumferential strain may be a promising parameter in the evaluation of the effectiveness of pericardiectomy.
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Affiliation(s)
- Li Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - You-Bin Deng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Kun Liu
- Department of Medical Ultrasound, Minda Hospital of Hubei University For Nationalities, Enshi, China
| | - Ling-Dan Guo
- Department of Medical Ultrasound, Wuhan Center Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong-Yun Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Zhou
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiao-Ying Tang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Revisiting annulus paradoxus in constrictive pericarditis. Int J Cardiol 2015; 195:288-9. [DOI: 10.1016/j.ijcard.2015.05.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 05/27/2015] [Indexed: 11/23/2022]
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Welch TD, Oh JK. Constrictive pericarditis: the mitral annulus remains paradoxical. Am J Cardiol 2015; 115:704. [PMID: 25577425 DOI: 10.1016/j.amjcard.2014.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 12/02/2014] [Accepted: 12/02/2014] [Indexed: 11/29/2022]
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12
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Annulus paradoxus and constrictive pericarditis: a need for revisiting the association! Am J Cardiol 2015; 115:554. [PMID: 25476562 DOI: 10.1016/j.amjcard.2014.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 06/25/2014] [Indexed: 11/21/2022]
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13
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Alraies MC, AlJaroudi W, Yarmohammadi H, Yingchoncharoen T, Schuster A, Senapati A, Tariq M, Kwon D, Griffin BP, Klein AL. Usefulness of cardiac magnetic resonance-guided management in patients with recurrent pericarditis. Am J Cardiol 2015; 115:542-7. [PMID: 25547939 DOI: 10.1016/j.amjcard.2014.11.041] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/17/2014] [Accepted: 11/17/2014] [Indexed: 11/16/2022]
Abstract
Recurrent pericarditis (RP) affects 10% to 50% of patients with acute pericarditis. The use of steroids has been associated with increased recurrence rate of pericarditis, along with known major side effects. Cardiac magnetic resonance imaging (CMR) is more frequently used to assess pericardial inflammation and less commonly to guide therapy. The aim of this study was to assess the utility of CMR in the management of RP compared with standard therapy. A total of 507 consecutive patients with RP after the first attack, all of whom were treated with colchicine and nonsteroidal anti-inflammatory drugs as first-line therapy, were retrospectively evaluated. There were 257 patients who were treated with medications and received CMR-guided therapy (group 1) and 250 patients who were treated with medications without CMR (group 2). The 2 groups had similar baseline characteristics and follow-up periods (17 ± 7.9 vs 16.3 ± 16.2 months, respectively, p = 0.97). CMR was used to assess the presence of pericardial inflammation, and on the basis of the results, the clinician made changes to the steroid dose dictated by the severity of inflammation. There was no significant difference in the incidence of constrictive pericarditis, pericardial window, or pericardiectomy between groups during the follow-up. However, group 2 patients had a larger number of steroid pulse therapies (defined as prednisone 50 mg/day orally for 10 days and tapering to none over 4 weeks), and higher overall total milligrams of steroid administered compared with the CMR group (p = 0.003 and p = 0.001, respectively). Recurrence and pericardiocentesis rates were lower in group 1 (p <0.0001). In conclusion, CMR-guided therapy modulates the management of RP. This approach decreased pericarditis recurrence and exposure to steroids.
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Affiliation(s)
- M Chadi Alraies
- Heart & Vascular Institute, Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio.
| | - Wael AlJaroudi
- Division of Cardiovascular Medicine, American University of Beirut, Beirut, Lebanon
| | - Hirad Yarmohammadi
- Heart & Vascular Institute, Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Teerapat Yingchoncharoen
- Heart & Vascular Institute, Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Andres Schuster
- Heart & Vascular Institute, Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Alpana Senapati
- Heart & Vascular Institute, Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Muhammad Tariq
- Heart & Vascular Institute, Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Deborah Kwon
- Heart & Vascular Institute, Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Brian P Griffin
- Heart & Vascular Institute, Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Allan L Klein
- Heart & Vascular Institute, Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio
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Abstract
Constrictive pericarditis can result from a stiff pericardium that prevents satisfactory diastolic filling. The distinction between constrictive pericarditis and other causes of heart failure, such as restrictive cardiomyopathy, is important because pericardiectomy can cure constrictive pericarditis. Diagnosis of constrictive pericarditis is based on characteristic haemodynamic and anatomical features determined using echocardiography, cardiac catheterization, cardiac MRI, and CT. The Mayo Clinic echocardiography and cardiac catheterization haemodynamic diagnostic criteria for constrictive pericarditis are based on the unique features of ventricular interdependence and dissociation of intrathoracic and intracardiac pressures seen when the pericardium is constricted. A complete pericardiectomy can restore satisfactory diastolic filling by removing the constrictive pericardium in patients with constrictive pericarditis. However, if inflammation of the pericardium is the predominant constrictive mechanism, anti-inflammatory therapy might alleviate this transient condition without a need for surgery. Early diagnosis of constrictive pericarditis is, therefore, of paramount clinical importance. An improved understanding of how constrictive pericarditis develops after an initiating event is critical to prevent this diastolic heart failure. In this Review, we discuss the aetiology, pathophysiology, and diagnosis of constrictive pericarditis, with a specific emphasis on how to differentiate this disease from conditions with similar clinical presentations.
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