1
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Truong KP, Press MC, Benharash P, Kar S, Lepor NE, Vorobiof G, Yang EH. Hemodynamic Manifestations of Concomitant Radiation-Induced Tricuspid Regurgitation and Pericardial Constriction Undergoing Transcatheter Tricuspid Valve Repair. Circ Heart Fail 2023; 16:e010170. [PMID: 37703079 DOI: 10.1161/circheartfailure.122.010170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Affiliation(s)
- Katie P Truong
- Division of Cardiology, Department of Medicine, University of Washington, Seattle (K.P.T.)
| | - Marcella Calfon Press
- Division of Cardiology, Department of Medicine (M.C.P., G.V., E.H.Y.), University of California at Los Angeles
| | - Peyman Benharash
- Division of Cardiothoracic Surgery, Department of Surgery (P.B.), University of California at Los Angeles
| | - Saibal Kar
- Cardiovascular Institute, Los Robles Regional Medical Center, Thousand Oaks, CA (S.K.)
| | - Norman E Lepor
- Division of Cardiology, Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA (N.E.L.)
| | - Gabriel Vorobiof
- Division of Cardiology, Department of Medicine (M.C.P., G.V., E.H.Y.), University of California at Los Angeles
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine (G.V., E.H.Y.), University of California at Los Angeles
- Cardiac PET Partners, Encino, CA (G.V.)
| | - Eric H Yang
- Division of Cardiology, Department of Medicine (M.C.P., G.V., E.H.Y.), University of California at Los Angeles
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine (G.V., E.H.Y.), University of California at Los Angeles
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2
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Lloyd JW, Anavekar NS, Oh JK, Miranda WR. Multimodality Imaging in Differentiating Constrictive Pericarditis From Restrictive Cardiomyopathy: A Comprehensive Overview for Clinicians and Imagers. J Am Soc Echocardiogr 2023; 36:1254-1265. [PMID: 37619909 DOI: 10.1016/j.echo.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/27/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
In the evaluation of heart failure, 2 differential diagnostic considerations include constrictive pericarditis and restrictive cardiomyopathy. The often outwardly similar clinical presentation of these 2 pathologic entities routinely renders their clinical distinction difficult. Consequently, initial assessment requires a keen understanding of their separate pathophysiology, epidemiology, and hemodynamic effects. Following a detailed clinical evaluation, further assessment initially rests on comprehensive echocardiographic investigation, including detailed Doppler evaluation. With the combination of mitral inflow characterization, tissue Doppler assessment, and hepatic vein interrogation, initial differentiation of constrictive pericarditis and restrictive cardiomyopathy is often possible with high sensitivity and specificity. In conjunction with a compatible clinical presentation, successful differentiation enables both an accurate diagnosis and subsequent targeted management. In certain cases, however, the diagnosis remains unclear despite echocardiographic assessment, and additional evaluation is required. With advances in noninvasive tools, such evaluation can often continue in a stepwise, algorithmic fashion noninvasively, including both cross-sectional and nuclear imaging. Should this additional evaluation itself prove insufficient, invasive assessment with appropriate expertise may ultimately be necessary.
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Affiliation(s)
- James W Lloyd
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nandan S Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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3
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Kato Y, Fukushima A, Iwano H, Kamiya K, Nagai T, Anzai T. A case of medical management of tricuspid regurgitation related to atrial fibrillation with constrictive pericarditis-like hemodynamics. J Cardiol Cases 2018; 18:175-179. [DOI: 10.1016/j.jccase.2018.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/09/2018] [Accepted: 07/25/2018] [Indexed: 11/16/2022] Open
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4
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Restrictive Cardiomyopathies: The Importance of Noninvasive Cardiac Imaging Modalities in Diagnosis and Treatment-A Systematic Review. Radiol Res Pract 2017; 2017:2874902. [PMID: 29270320 PMCID: PMC5705874 DOI: 10.1155/2017/2874902] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/02/2017] [Indexed: 12/19/2022] Open
Abstract
Restrictive cardiomyopathy (RCM) is the least common among cardiomyopathies. It can be idiopathic, familial, or secondary to systematic disorders. Marked increase in left and/or right ventricular filling pressures causes symptoms and signs of congestive heart failure. Electrocardiographic findings are nonspecific and include atrioventricular conduction and QRS complex abnormalities and supraventricular and ventricular arrhythmias. Echocardiography and cardiac magnetic resonance (CMR) play a major role in diagnosis. Echocardiography reveals normal or hypertrophied ventricles, preserved systolic function, marked biatrial enlargement, and impaired diastolic function, often with restrictive filling pattern. CMR offering a higher spatial resolution than echocardiography can provide detailed information about anatomic structures, perfusion, ventricular function, and tissue characterization. CMR with late gadolinium enhancement (LGE) and novel approaches (myocardial mapping) can direct the diagnosis to specific subtypes of RCM, depending on the pattern of scar formation. When noninvasive studies have failed, endomyocardial biopsy is required. Differentiation between RCM and constrictive pericarditis (CP), nowadays by echocardiography, is important since both present as heart failure with normal-sized ventricles and preserved ejection fraction but CP can be treated by means of anti-inflammatory and surgical treatment, while the treatment options of RCM are dictated by the underlying condition. Prognosis is generally poor despite optimal medical treatment.
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5
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Abstract
Pericardial diseases can be classified broadly as 3 entities: acute pericarditis, cardiac tamponade, and constrictive pericarditis. These disorders can be diagnosed and managed with noninvasive studies following a comprehensive history and physical examination, without the need for cardiac catheterization in most patients. Despite the advances in noninvasive cardiac imaging, there are limitations to their diagnostic accuracy. The invasive hemodynamic study offers the advantage of simultaneous, direct pressure measurement across multiple chambers, with direct examination of blood flow. Herein, the authors review the techniques for obtaining and interpreting invasive hemodynamic data in patients with suspected pericardial disease.
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Affiliation(s)
- Ganesh Athappan
- Valve Science Center, Minneapolis Heart Institute Foundation, 800 East 28th Street, Minneapolis, MN 55407, USA; Center for Valve and Structural Heart Disease, Minneapolis Heart Institute, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN 55407, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, 800 East 28th Street, Minneapolis, MN 55407, USA; Center for Valve and Structural Heart Disease, Minneapolis Heart Institute, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN 55407, USA.
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6
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Sorajja P, Borlaug BA, Dimas VV, Fang JC, Forfia PR, Givertz MM, Kapur NK, Kern MJ, Naidu SS. SCAI/HFSA clinical expert consensus document on the use of invasive hemodynamics for the diagnosis and management of cardiovascular disease. Catheter Cardiovasc Interv 2017; 89:E233-E247. [PMID: 28489331 DOI: 10.1002/ccd.26888] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/20/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Paul Sorajja
- Center for Valve and Structural Heart Disease, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Barry A Borlaug
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Vasiliki V Dimas
- Childrens Health Dallas, University of Texas Southwestern Medical Center, Dallas, Texas
| | - James C Fang
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Paul R Forfia
- Section of Cardiology, Temple University, Philadelphia, Pennsylvania
| | - Michael M Givertz
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Navin K Kapur
- Division of Cardiology, Tufts University School of Medicine, Boston, Massachusetts
| | - Morton J Kern
- Cardiology Services, University of California Irvine, Irvine, California
| | - Srihari S Naidu
- Division of Cardiology, Westchester Medical Center, Valhalla, New York
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7
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Sorajja P, Borlaug BA, Dimas V, Fang JC, Forfia PR, Givertz MM, Kapur NK, Kern MJ, Naidu SS. Executive summary of the SCAI/HFSA clinical expert consensus document on the use of invasive hemodynamics for the diagnosis and management of cardiovascular disease. Catheter Cardiovasc Interv 2017; 89:1294-1299. [DOI: 10.1002/ccd.27036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 02/25/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Paul Sorajja
- Minneapolis Heart Institute at Abbott Northwestern Hospital; Minneapolis Minnesota
| | | | - Vivian Dimas
- University of Texas Southwestern Medical Center; Dallas Texas
| | - James C. Fang
- University of Utah School of Medicine; Salt Lake City Utah
| | | | | | - Navin K. Kapur
- Tufts University School of Medicine; Boston Massachusetts
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8
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Givertz MM, Fang JC, Sorajja P, Dimas V, Forfia PR, Kapur NK, Kern MJ, Naidu SS, Borlaug BA. Executive Summary of the SCAI/HFSA Clinical Expert Consensus Document on the Use of Invasive Hemodynamics for the Diagnosis and Management of Cardiovascular Disease. J Card Fail 2017; 23:487-491. [PMID: 28454731 DOI: 10.1016/j.cardfail.2017.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 02/25/2017] [Indexed: 01/02/2023]
Affiliation(s)
| | - James C Fang
- University of Utah School of Medicine, Salt Lake City, Utah
| | - Paul Sorajja
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Vivian Dimas
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Navin K Kapur
- Tufts University School of Medicine, Boston, Massachusetts
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9
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Abstract
BACKGROUND Patients with severe tricuspid regurgitation (TR) frequently present with exertional fatigue and dyspnea, but the hemodynamic basis for exercise limitation in people with TR remains unclear. METHODS AND RESULTS Twelve subjects with normal left ventricular (LV) ejection fraction and grade ≥3 TR underwent high-fidelity invasive hemodynamic exercise testing with simultaneous expired gas analysis and were compared with 13 age- and sex-matched controls. At rest, TR subjects had lower pulmonary blood flow (3.6±0.4 versus 5.1±1.9 L/min; P=0.01), increased right atrial pressure (12±5 versus 4±1 mm Hg; P=0.0002), and higher pulmonary capillary wedge pressure (17±5 versus 9±3 mm Hg; P=0.0001). However, LV transmural pressure (pulmonary capillary wedge pressure-right atrial pressure), which reflects LV preload independent of right heart congestion and pericardial restraint, was similar in TR and controls (6±3 versus 4±2 mm Hg; P=0.3). With exercise, TR subjects displayed lower peak VO2 (10.3±2.8 versus 13.8±4.2 mL/min per kg; P=0.02), lower pulmonary blood flow (6.4±1.3 versus 10.3±3.3 L/min; P=0.001), and less increase in pulmonary blood flow relative to VO2 (+4.6±1.1vs +6.2±0.7; P=0.001). TR subjects displayed higher pulmonary capillary wedge pressure with exercise, but this was solely because of RA hypertension (27±9 versus 8±3 mm Hg; P<0.0001), because LV transmural pressure dropped with exercise in subjects with TR (-5±6 versus +3±3 mm Hg; P=0.0007), suggesting inadequate LV diastolic filling, despite high pulmonary capillary wedge pressure. CONCLUSIONS Impaired exercise capacity in people with severe TR is related to low cardiac output reserve relative to metabolic needs, coupled with elevated systemic and pulmonary venous pressures. Left heart pressures are elevated with exercise in subjects with TR, despite low LV preload, secondary to enhanced ventricular interaction.
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Affiliation(s)
- Mads J Andersen
- From the Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, MN (M.J.A., R.A.N., B.A.B.); and Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (M.J.A.)
| | - Rick A Nishimura
- From the Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, MN (M.J.A., R.A.N., B.A.B.); and Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (M.J.A.)
| | - Barry A Borlaug
- From the Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, MN (M.J.A., R.A.N., B.A.B.); and Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (M.J.A.).
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10
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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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11
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Ozpelit E, Akdeniz B, Ozpelit ME, Göldeli O. Severe tricuspid regurgitation mimicking constrictive pericarditis. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:271-4. [PMID: 24995118 PMCID: PMC4079647 DOI: 10.12659/ajcr.890092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 02/06/2014] [Indexed: 11/09/2022]
Abstract
Patient: Female, 62 Final Diagnosis: Tricuspid regurgitation Symptoms: Dyspnea exertional • fatigue • leg edema Medication: — Clinical Procedure: — Specialty: Cardiology
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Affiliation(s)
- Ebru Ozpelit
- Department of Cardiology, Dokuz Eylul University, School of Medicine, Izmir, Turkey
| | - Bahri Akdeniz
- Department of Cardiology, Dokuz Eylul University, School of Medicine, Izmir, Turkey
| | - Mehmet Emre Ozpelit
- Department of Cardiology, Izmir University, School of Medicine, Medicalpark Hospital, Izmir, Turkey
| | - Ozhan Göldeli
- Department of Cardiology, Dokuz Eylul University, School of Medicine, Izmir, Turkey
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12
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Welch TD, Ling LH, Espinosa RE, Anavekar NS, Wiste HJ, Lahr BD, Schaff HV, Oh JK. Echocardiographic Diagnosis of Constrictive Pericarditis. Circ Cardiovasc Imaging 2014; 7:526-34. [DOI: 10.1161/circimaging.113.001613] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background—
Constrictive pericarditis is a potentially reversible cause of heart failure that may be difficult to differentiate from restrictive myocardial disease and severe tricuspid regurgitation. Echocardiography provides an important opportunity to evaluate for constrictive pericarditis, and definite diagnostic criteria are needed.
Methods and Results—
Patients with surgically confirmed constrictive pericarditis (n=130) at Mayo Clinic (2008–2010) were compared with patients (n=36) diagnosed with restrictive myocardial disease or severe tricuspid regurgitation after constrictive pericarditis was considered but ruled out. Comprehensive echocardiograms were reviewed in blinded fashion. Five principal echocardiographic variables were selected based on prior studies and potential for clinical use: (1) respiration-related ventricular septal shift, (2) variation in mitral inflow E velocity, (3) medial mitral annular e' velocity, (4) ratio of medial mitral annular e' to lateral e', and (5) hepatic vein expiratory diastolic reversal ratio. All 5 principal variables differed significantly between the groups. In patients with atrial fibrillation or flutter (n=29), all but mitral inflow velocity remained significantly different. Three variables were independently associated with constrictive pericarditis: (1) ventricular septal shift, (2) medial mitral e', and (3) hepatic vein expiratory diastolic reversal ratio. The presence of ventricular septal shift in combination with either medial e'≥9 cm/s or hepatic vein expiratory diastolic reversal ratio ≥0.79 corresponded to a desirable combination of sensitivity (87%) and specificity (91%). The specificity increased to 97% when all 3 factors were present, but the sensitivity decreased to 64%.
Conclusions—
Echocardiography allows differentiation of constrictive pericarditis from restrictive myocardial disease and severe tricuspid regurgitation. Respiration-related ventricular septal shift, preserved or increased medial mitral annular e' velocity, and prominent hepatic vein expiratory diastolic flow reversals are independently associated with the diagnosis of constrictive pericarditis.
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Affiliation(s)
- Terrence D. Welch
- From the Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (T.D.W.); Geisel School of Medicine at Dartmouth, Hanover, NH (T.D.W.); National University Heart Center, Singapore, Singapore (L.H.L.); Yong Loo Lin School of Medicine, Singapore, Singapore (L.H.L.); and Division of Cardiovascular Diseases (R.E.E., N.S.A., J.K.O.), Department of Health Sciences Research (H.J.W., B.D.L.), and Division of Cardiovascular Surgery (H.V.S.), Mayo Clinic, Rochester, MN
| | - Lieng H. Ling
- From the Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (T.D.W.); Geisel School of Medicine at Dartmouth, Hanover, NH (T.D.W.); National University Heart Center, Singapore, Singapore (L.H.L.); Yong Loo Lin School of Medicine, Singapore, Singapore (L.H.L.); and Division of Cardiovascular Diseases (R.E.E., N.S.A., J.K.O.), Department of Health Sciences Research (H.J.W., B.D.L.), and Division of Cardiovascular Surgery (H.V.S.), Mayo Clinic, Rochester, MN
| | - Raul E. Espinosa
- From the Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (T.D.W.); Geisel School of Medicine at Dartmouth, Hanover, NH (T.D.W.); National University Heart Center, Singapore, Singapore (L.H.L.); Yong Loo Lin School of Medicine, Singapore, Singapore (L.H.L.); and Division of Cardiovascular Diseases (R.E.E., N.S.A., J.K.O.), Department of Health Sciences Research (H.J.W., B.D.L.), and Division of Cardiovascular Surgery (H.V.S.), Mayo Clinic, Rochester, MN
| | - Nandan S. Anavekar
- From the Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (T.D.W.); Geisel School of Medicine at Dartmouth, Hanover, NH (T.D.W.); National University Heart Center, Singapore, Singapore (L.H.L.); Yong Loo Lin School of Medicine, Singapore, Singapore (L.H.L.); and Division of Cardiovascular Diseases (R.E.E., N.S.A., J.K.O.), Department of Health Sciences Research (H.J.W., B.D.L.), and Division of Cardiovascular Surgery (H.V.S.), Mayo Clinic, Rochester, MN
| | - Heather J. Wiste
- From the Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (T.D.W.); Geisel School of Medicine at Dartmouth, Hanover, NH (T.D.W.); National University Heart Center, Singapore, Singapore (L.H.L.); Yong Loo Lin School of Medicine, Singapore, Singapore (L.H.L.); and Division of Cardiovascular Diseases (R.E.E., N.S.A., J.K.O.), Department of Health Sciences Research (H.J.W., B.D.L.), and Division of Cardiovascular Surgery (H.V.S.), Mayo Clinic, Rochester, MN
| | - Brian D. Lahr
- From the Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (T.D.W.); Geisel School of Medicine at Dartmouth, Hanover, NH (T.D.W.); National University Heart Center, Singapore, Singapore (L.H.L.); Yong Loo Lin School of Medicine, Singapore, Singapore (L.H.L.); and Division of Cardiovascular Diseases (R.E.E., N.S.A., J.K.O.), Department of Health Sciences Research (H.J.W., B.D.L.), and Division of Cardiovascular Surgery (H.V.S.), Mayo Clinic, Rochester, MN
| | - Hartzell V. Schaff
- From the Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (T.D.W.); Geisel School of Medicine at Dartmouth, Hanover, NH (T.D.W.); National University Heart Center, Singapore, Singapore (L.H.L.); Yong Loo Lin School of Medicine, Singapore, Singapore (L.H.L.); and Division of Cardiovascular Diseases (R.E.E., N.S.A., J.K.O.), Department of Health Sciences Research (H.J.W., B.D.L.), and Division of Cardiovascular Surgery (H.V.S.), Mayo Clinic, Rochester, MN
| | - Jae K. Oh
- From the Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (T.D.W.); Geisel School of Medicine at Dartmouth, Hanover, NH (T.D.W.); National University Heart Center, Singapore, Singapore (L.H.L.); Yong Loo Lin School of Medicine, Singapore, Singapore (L.H.L.); and Division of Cardiovascular Diseases (R.E.E., N.S.A., J.K.O.), Department of Health Sciences Research (H.J.W., B.D.L.), and Division of Cardiovascular Surgery (H.V.S.), Mayo Clinic, Rochester, MN
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13
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Howard JP, Jones D, Mills P, Marley R, Wragg A. Recurrent ascites due to constrictive pericarditis. Frontline Gastroenterol 2012; 3:233-237. [PMID: 28839673 PMCID: PMC5369818 DOI: 10.1136/flgastro-2012-100173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 05/07/2012] [Indexed: 02/04/2023] Open
Affiliation(s)
- James Philip Howard
- NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK,Department of Cardiology, Barts and the London NHS Trust, London, UK
| | - Daniel Jones
- NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK,Department of Cardiology, Barts and the London NHS Trust, London, UK
| | - Peter Mills
- NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK
| | - Richard Marley
- Department of Gastroenterology, Barts and the London NHS Trust, London, UK
| | - Andrew Wragg
- NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK,Department of Cardiology, Barts and the London NHS Trust, London, UK
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14
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Rao S, Tate D, Stouffer G. Hemodynamic findings in severe tricuspid regurgitation. Catheter Cardiovasc Interv 2012; 81:162-9. [DOI: 10.1002/ccd.24309] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 12/24/2011] [Indexed: 11/10/2022]
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15
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Affiliation(s)
- Rick A. Nishimura
- From the Mayo Clinic College of Medicine, Rochester, MN (R.A.N.), and Baylor College of Medicine, Houston, TX (B.A.C.)
| | - Blase A. Carabello
- From the Mayo Clinic College of Medicine, Rochester, MN (R.A.N.), and Baylor College of Medicine, Houston, TX (B.A.C.)
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16
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Almanac 2011: valvular heart disease. The national society journals present selected research that has driven recent advances in clinical cardiology. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.repce.2012.04.009] [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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17
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Almanac 2011: valvular heart disease. The national society journals present selected research that has driven recent advances in clinical cardiology. Rev Port Cardiol 2012; 31:337-50. [DOI: 10.1016/j.repc.2012.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 01/04/2012] [Indexed: 11/21/2022] Open
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18
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Rosenhek R. Almanac 2011: Valvular heart disease. The national society journals present selected research that has driven recent advances in clinical cardiology. Egypt Heart J 2012. [DOI: 10.1016/j.ehj.2012.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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19
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Sorajja P. Invasive Hemodynamics of Constrictive Pericarditis, Restrictive Cardiomyopathy, and Cardiac Tamponade. Cardiol Clin 2011; 29:191-9. [DOI: 10.1016/j.ccl.2011.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Abstract
Background—
Respiratory dependence of tricuspid regurgitation (TR), a long-held concept suggested by murmur variation, remains unproven and of unclear mechanisms.
Methods and Results—
In 41 patients with mild or greater TR (median age, 67 years), we performed triple Doppler echocardiographic quantification (TR severity, right ventricular, and right atrial quantification) with simultaneous respirometer recording of respiratory phases. Expiration to inspiration changes (median) affected TR peak velocity (−40 cm/s; 25th to 75th percentile, −60 to −30 cm/s), duration (−12 milliseconds; 25th to 75th percentile, −45 to 2 milliseconds), and time-velocity integral (−17 cm; 25th to 75th percentile, −23.4 to −10 cm; all
P
<0.001), consistent with decreased TR driving force. Nevertheless, inspiratory TR augmentation was demonstrated by increased effective regurgitant orifice (0.21 cm
2
; 25th to 75th percentile, 0.09 to 0.34 cm
2
) and volume (18 mL per beat; 25th to 75th percentile, 10 to 25 mL per beat; all
P
<0.001) infrequently detected clinically (2 of 41, 5). As a result of reduced TR driving force, regurgitant volume increased less than effective regurgitant orifice (120 [25th to 75th percentile, 78.6 to 169] versus 169 [ 25th to 75th percentile, 12.9 to 226.1];
P
<0.001). During inspiration, right ventricular area increased (diastolic, 27.8 [25th to 75th percentile, 22.6 to 36.3] versus 26.5 [21.1 to 31.9];
P
<0.0001) with widening of right ventricular shape (length-to-width ratio, 1.6 [ 25th to 75th percentile, 1.37 to 1.95] versus 1.7 [1.46 to 2.1];
P
<0.0001), increased systolic annular diameter (
P
=0.003), valve tenting height (
P
<0.0001) and area (
P
<0.0001), and reduced valvular-to-annular ratio (
P
=0.006). Effective regurgitant orifice during inspiration was independently determined by inspiratory valvular-to-annular ratio (
P
=0.026) and inspiratory change in right ventricular length-to-width ratio (
P
=0.008) and valve tenting area (
P
=0.015).
Conclusions—
TR is dynamic with almost universal respiratory changes of large magnitude and complex pathophysiology. During inspiration, a large increase in effective regurgitant orifice causes, despite a decline in regurgitant gradient, a notable increase in regurgitant volume. Effective regurgitant orifice changes are independently linked to inspiratory annular enlargement (decreased valvular coverage) and to inspiratory right ventricular shape widening with increased valvular tenting. These novel physiological insights into TR respiratory dependence underscore right-side heart plasticity and are important for clinical TR severity evaluation.
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