1
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Botros MB, Narvaez-Guerra O, Harrington CM, Aurigemma GP. Annulus Reversus Caused by Transmural Scar in a Patient With Myopericarditis. CASE (PHILADELPHIA, PA.) 2023; 7:68-71. [PMID: 36861098 PMCID: PMC9968902 DOI: 10.1016/j.case.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Annulus reversus is thought to be specific to chronic constrictive pericarditis. Myocardial scarring of the LV wall may present with reduced longitudinal wall motion. Scar in the lateral wall may contribute to the finding of annulus reversus.
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Affiliation(s)
| | - Offdan Narvaez-Guerra
- UMass Chan Medical School, Worcester, Massachusetts,Division of Cardiovascular Medicine, UMass Chan Medical School, Worcester, Massachusetts
| | - Colleen M. Harrington
- Division of Cardiology, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Gerard P. Aurigemma
- UMass Chan Medical School, Worcester, Massachusetts,Division of Cardiovascular Medicine, UMass Chan Medical School, Worcester, Massachusetts,Correspondence: Gerard P. Aurigemma, MD, UMass Chan Medical School, Room ACC4: 240, 55 Lake Avenue North, Worcester, MA 01655.
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2
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Grewal HK, Bansal M. Echocardiographic Differentiation of Pericardial Constriction and Left Ventricular Restriction. Curr Cardiol Rep 2022; 24:1599-1610. [PMID: 36040551 DOI: 10.1007/s11886-022-01774-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW Overlapping hemodynamics in constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM) often pose difficulties in establishing accurate diagnosis. Echocardiography is the first-line imaging modality used for this purpose, but no single echocardiographic parameter is sufficiently robust for distinguishing between the two conditions. The newer developments may improve the diagnostic accuracy of echocardiography in this setting. RECENT FINDINGS Recent studies have validated multiparametric algorithms, based on conventional echocardiographic parameters, which enable high sensitivity and specificity for distinguishing between CP and RCM. In addition, myocardial deformation analysis using speckle-tracking echocardiography has revealed distinct pattern of abnormalities in the two conditions. CP is characterized by impaired left ventricular apical rotation with relatively preserved longitudinal strain, esp. of ventricular and atrial septum. In contrast, RCM results in global and marked impairment of left ventricular longitudinal strain with initially preserved circumferential mechanics. Combining multiple echocardiographic parameters into step-wise algorithms and incorporation of myocardial deformation analysis help improve the diagnostic accuracy of echocardiography for distinguishing between CP and RCM. The use of machine-learning may allow easy integration of a wide range of echocardiographic and clinical parameters to permit accurate, automated diagnosis, with less dependence on the user expertise.
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Affiliation(s)
- Hardeep Kaur Grewal
- Medanta Heart Institute, Medanta - The Medicity, Gurgaon, Haryana, 122001, India
| | - Manish Bansal
- Medanta Heart Institute, Medanta - The Medicity, Gurgaon, Haryana, 122001, India.
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3
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Sohal S, Mathai SV, Lipat K, Kaur A, Visveswaran G, Cohen M, Waxman S, Tiwari N, Vucic E. Multimodality Imaging of Constrictive Pericarditis: Pathophysiology and New Concepts. Curr Cardiol Rep 2022; 24:1439-1453. [PMID: 35917048 PMCID: PMC9344806 DOI: 10.1007/s11886-022-01758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/15/2022]
Abstract
Purpose of Review The unique pathophysiological changes of constrictive pericarditis (CP) can now be identified with better imaging modalities, thereby helping in its early diagnosis. Through this review, we outline the pathophysiology of CP and its translation into symptomology and various imaging findings which then are used for both diagnosis and guiding treatment options for CP. Recent Findings Multimodality imaging has provided us with the capability to recognize early stages of the disease and identify patients with a potential for reversibility and can be treated with medical management. Additionally, peri-procedural planning and prediction of post-operative complications has been made possible with the use of advanced imaging techniques. Summary Advanced imaging has the potential to play a greater role in identification of patients with reversible disease process and provide peri-procedural risk stratification, thereby improving outcomes for patients with CP.
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Affiliation(s)
- Sumit Sohal
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA.
| | - Sheetal Vasundara Mathai
- Division of Cardiovascular Diseases, Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Kevin Lipat
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Arpanjeet Kaur
- Department of Medicine, Mount Sinai West, 1000 Tenth Avenue, New York, NY, 10019, USA
| | - Gautam Visveswaran
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Marc Cohen
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Sergio Waxman
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Nidhish Tiwari
- Division of Cardiovascular Diseases, Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Esad Vucic
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
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4
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Haq IU, Davies DR, Yao R, Bratt A, Sinak LJ, Singh M. Effusive-Constrictive Tuberculosis Pericarditis with Biventricular Systolic Dysfunction. CASE 2022; 6:212-217. [PMID: 35832826 PMCID: PMC9271481 DOI: 10.1016/j.case.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Tuberculosis is a rare etiology of effusive-constrictive pericarditis. It can present with systolic dysfunction, irrespective of myocardial involvement. Anti-TB and steroid therapy are reasonable treatment options.
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Affiliation(s)
- Ikram U. Haq
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniel R. Davies
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rebecca Yao
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Alex Bratt
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Lawrence J. Sinak
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- Correspondence: Mandeep Singh, MD, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
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5
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Brown MT, McDowell AC, Clements SD, Dressler DD. Here's the rub: A case of constrictive pericarditis in an adult with cystic fibrosis. Respir Med Case Rep 2021; 33:101434. [PMID: 34401277 PMCID: PMC8349017 DOI: 10.1016/j.rmcr.2021.101434] [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: 12/07/2020] [Revised: 05/18/2021] [Accepted: 05/27/2021] [Indexed: 11/21/2022] Open
Abstract
We present a rare coexistence of constrictive pericarditis in a patient with cystic fibrosis. Careful attention to cardiac friction rub auscultated on initial examination prompted echocardiography revealing constrictive pericarditis further confirmed by cardiac magnetic resonance imaging that allowed for dedicated treatment in addition to management of his concurrent respiratory infection. Only the third reported case of constrictive pericarditis in a patient with cystic fibrosis. Symptoms of severe cystic fibrosis and constrictive pericarditis are similar. Cardiac knocks or friction rubs should raise suspicion for a pericardial process. Annulus paradoxus and reversus are echo hallmarks for constrictive pericarditis. Management of constrictive pericarditis requires dedicated treatment and monitoring.
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Affiliation(s)
- Matthew T Brown
- J Willis Hurst Internal Medicine Residency Program, USA.,Department of Medicine, Emory University, Atlanta, GA, USA
| | - Ashley C McDowell
- J Willis Hurst Internal Medicine Residency Program, USA.,Department of Medicine, Emory University, Atlanta, GA, USA
| | - Stephen D Clements
- Department of Medicine, Emory University, Atlanta, GA, USA.,Division of Cardiology, USA
| | - Daniel D Dressler
- J Willis Hurst Internal Medicine Residency Program, USA.,Department of Medicine, Emory University, Atlanta, GA, USA.,Division of Hospital Medicine, USA
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6
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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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7
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Yu S, Peffley S, Fabbro M, Mohammed AN. A Narrative Review of the 2020 Guidelines for Use of Transesophageal Echocardiography to Assist with Surgical Decision- Making by the Cardiac Anesthesiologist in the Operating Room. J Cardiothorac Vasc Anesth 2021; 36:258-274. [PMID: 33744115 DOI: 10.1053/j.jvca.2021.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 01/25/2023]
Abstract
Transesophageal echocardiography (TEE) has become an integral part in helping to diagnose, manage, and assess interventions in the cardiac operating room. Multiple guidelines have been created by the American Society of Echocardiography for performing a TEE examination for different cardiac pathologies. The operating room can provide unique challenges when performing a TEE examination, which include hemodynamic instability, time constraints, and use of general anesthesia. The Guideline for the use of TEE to assist in surgical decision- making in the operating room recently was published to provide a starting protocol for conducting a TEE examination for different cardiac surgeries and for using the information obtained to interpret and to communicate findings to the surgical team. This present narrative review focuses and expands upon the relevant portions for the cardiac anesthesiologist.
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Affiliation(s)
- Soojie Yu
- Department of Anesthesiology, University of Arizona College of Medicine, Tucson, AZ.
| | - Sultana Peffley
- Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, FL
| | - Michael Fabbro
- Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, FL
| | - Asif Neil Mohammed
- Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, FL
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8
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The Role of Echocardiography in the Cancer Patient. Curr Cardiol Rep 2020; 22:103. [PMID: 32770406 DOI: 10.1007/s11886-020-01373-3] [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] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW To review the uses of echocardiography in patients with cancer and how it has expanded beyond the typical monitoring of systolic function during potentially cardiotoxic cancer therapeutics. RECENT FINDINGS In addition to myocardial strain imaging being a predictor of subsequent left ventricular dysfunction, it can be used for pattern recognition to help identify patients with cardiac amyloidosis or Takotsubo cardiomyopathy. Echocardiography is essential for diagnosis and planning of intervention for aortic stenosis in radiation-induced valvular disease, for which transcutaneous aortic valve replacement that gives many cancer patients that are not surgical candidates an option for treatment. The safety of transesophageal echocardiography has recently been demonstrated in patients with cancer with thrombocytopenia and depleted white blood cell counts who are at increased risk of endocarditis. Echocardiography is an essential tool for evaluating common conditions in cancer patients such as pericardial disease, radiation-induced heart disease, and intracardiac tumors-with specific uses of specialized echocardiography techniques such as deformation imaging, transesophageal echocardiography, and point-of-care ultrasound.
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9
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Sunderji I, Singh V, Fraser AG. When does the E/e’ index not work? The pitfalls of oversimplifying diastolic function. Echocardiography 2020; 37:1897-1907. [DOI: 10.1111/echo.14697] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
| | - Vickram Singh
- Department of Cardiology University Hospital of Wales Cardiff UK
| | - Alan G. Fraser
- Department of Cardiology University Hospital of Wales Cardiff UK
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10
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Kim MS, Chang SA, Kim EK, Choi JO, Park SJ, Lee SC, Park SW, Oh JK. The Clinical Course of Tuberculous Pericarditis in Immunocompetent Hosts Based on Serial Echocardiography. Korean Circ J 2020; 50:599-609. [PMID: 32096358 PMCID: PMC7321756 DOI: 10.4070/kcj.2019.0317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/26/2019] [Accepted: 12/18/2019] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives In East Asia, tuberculous pericarditis still occurs in immunocompetent patients. We aimed to investigate clinical course of tuberculous pericarditis and the trends of echocardiographic parameters for constrictive pericarditis. Methods We retrospectively analyzed medical records of patients with tuberculous pericarditis between January 2010 and January 2017 in Samsung Medical Center. Treatment consists of the standard 4-drug anti-tuberculosis regimen for 6 months with or without corticosteroids. We performed echocardiography at initial diagnosis, 1, 3 and 6 months later. Results Total 50 cases with tuberculous pericarditis in immunocompetent patients were enrolled. Echocardiographic finding at initial diagnosis divided into 3 groups: 1) pericardial effusion only (n=28, 56.0%), 2) effusive constrictive pericarditis (n=10, 20.0%) and 3) constrictive pericarditis (n=12, 24.0%). The proportion of patients with constrictive pericarditis decreased gradually over time. After 6 months, only 5 patients still had constrictive pericarditis. Out of the 28 patients who initially presented with effusion alone, only one patient developed constrictive pericarditis. Echocardiographic parameters representing constrictive pericarditis gradually disappeared over the follow up period. Ventricular interdependency improved significantly from 1 month follow-up, whereas septal bounce and pericardial thickening were still observed after 6 months without significant constrictive physiology. Conclusions Tuberculous pericarditis with pericardial effusion without constrictive physiology is unlikely to develop into constrictive pericarditis in immunocompetent hosts, if treated with optimal anti-tuberculous medication and steroid therapy. Even though there were hemodynamic feature of constrictive pericarditis, more than 80% of the patients were improved from constrictive pericarditis.
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Affiliation(s)
- Min Sun Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung A Chang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Ji Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Chol Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae K Oh
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
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11
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Kim MS, Chang SA. Author's Reply to Septal Bounce or Ventricle Interdependence in Constrictive Pericarditis: Same or Different. Korean Circ J 2020; 50:630-631. [PMID: 32588572 PMCID: PMC7321757 DOI: 10.4070/kcj.2020.1781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/24/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Min Sun Kim
- Division of Cardiology, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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12
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Desai MY, Jellis CL, Kotecha R, Johnston DR, Griffin BP. Radiation-Associated Cardiac Disease: A Practical Approach to Diagnosis and Management. JACC Cardiovasc Imaging 2019; 11:1132-1149. [PMID: 30092970 DOI: 10.1016/j.jcmg.2018.04.028] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 01/14/2023]
Abstract
Radiation-associated cardiac disease (RACD) results in complex clinical presentations, unique management issues, and increased morbidity and mortality. Patients typically present years or even decades after radiation exposure, with delayed-onset cardiac damage sustained from high cumulative doses. Multimodality imaging is crucial to determine the manifestations and severity of disease because symptoms are often nonspecific. Comprehensive screening using a coordinated approach may enable early detection. However, timing of intervention should be carefully considered in these patients because surgery is often complex and high-risk second surgeries should be minimized in the long-term. This review aims to provide treating physicians with a comprehensive and clinically focused overview of RACD, including clinical/imaging manifestations, multi-modality screening recommendations, and management options.
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Affiliation(s)
- Milind Y Desai
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | | | - Rupesh Kotecha
- Department of Radiation Oncology, Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Brian P Griffin
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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13
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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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14
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Yang JH, Miranda WR, Borlaug BA, Nishimura RA, Schaff HV, Greason KL, Maleszewski JJ, Oh JK. Right Atrial/Pulmonary Arterial Wedge Pressure Ratio in Primary and Mixed Constrictive Pericarditis. J Am Coll Cardiol 2019; 73:3312-3321. [DOI: 10.1016/j.jacc.2019.03.522] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 12/14/2022]
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15
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Quispe R, Villablanca PA, García M. Pericarditis constrictiva: multimodalidad. REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2018.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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16
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Chetrit M, Xu B, Verma BR, Klein AL. Multimodality Imaging for the Assessment of Pericardial Diseases. Curr Cardiol Rep 2019; 21:41. [DOI: 10.1007/s11886-019-1115-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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17
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Silbiger JJ. Pathophysiology and Echocardiographic Diagnosis of Left Ventricular Diastolic Dysfunction. J Am Soc Echocardiogr 2019; 32:216-232.e2. [DOI: 10.1016/j.echo.2018.11.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Indexed: 12/30/2022]
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18
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Del Buono MG, Buckley L, Abbate A. Primary and Secondary Diastolic Dysfunction in Heart Failure With Preserved Ejection Fraction. Am J Cardiol 2018; 122:1578-1587. [PMID: 30220416 DOI: 10.1016/j.amjcard.2018.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/13/2018] [Accepted: 07/17/2018] [Indexed: 12/28/2022]
Abstract
Approximately 50% of patients with symptoms and signs of heart failure have a left ventricular ejection fraction (LVEF) ≥50% and are often simply referred to as 'heart failure with preserved EF', 'HFpEF'. Many of such patients have HF secondary to specific cardiac conditions (i.e., valvular or pericardial disease) in which the symptoms and signs occur despite the LVEF being preserved due to diastolic dysfunction secondary to the underlying disease (secondary HFpEF), differently from those HFpEF patients in which the impaired LV filling is due to a primary diastolic dysfunction (primary HFpEF). When primary HFpEF patients are properly diagnosed, they appear to have a milder form of HF with a lower cardiovascular mortality compared with HFrEF and secondary HFpEF population, but a risk of HF hospitalization that is significantly higher than patients with similar cardiovascular risk factors but without the diagnosis of HFpEF. We herein review the diagnostic approach to HFpEF and present a differential diagnosis of HFpEF in a primary and secondary form.
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19
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Abstract
Pericardial diseases represent diverse conditions, ranging from painful inflammatory states, such as acute pericarditis, to life-threatening tamponade and chronic heart failure due to constrictive pericarditis. Multimodality cardiovascular imaging plays important roles in diagnosis and management of pericardial conditions. This review provides a clinical update on multimodality cardiovascular imaging of the pericardium, incorporating echocardiography, multidetector computed tomography, and cardiac magnetic resonance imaging, focusing on guiding clinicians about when each cardiac imaging modality should be used in each relevant pericardial condition.
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Affiliation(s)
- Bo Xu
- Section of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Desk J1-5, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Deborah H Kwon
- Section of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Desk J1-5, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Allan L Klein
- Section of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Desk J1-5, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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20
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Abstract
Constrictive pericarditis (CP) is defined as impedance to diastolic filling caused by a fibrotic pericardium. The diagnosis of CP is a clinical challenge and requires a high index of clinical suspicion. The signs and symptoms of CP include fatigue, edema, ascites, and liver dysfunction. These can be mistakenly diagnosed as primary liver disease. We present the case of a 69-year-old woman with a 7-year history of leg edema and a 2-year history of ascites who was initially diagnosed with cryptogenic liver cirrhosis and was finally diagnosed with CP.
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Affiliation(s)
- Takahiro Kamio
- Heart Center, Tokyo Bay Urayasu-Ichikawa Medical Center, Japan
| | - Eiji Hiraoka
- Department of Internal Medicine, Tokyo Bay Urayasu-Ichikawa Medical Center, Japan
| | - Kotaro Obunai
- Heart Center, Tokyo Bay Urayasu-Ichikawa Medical Center, Japan
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21
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Mahmoud A, Bansal M, Sengupta PP. New Cardiac Imaging Algorithms to Diagnose Constrictive Pericarditis Versus Restrictive Cardiomyopathy. Curr Cardiol Rep 2018; 19:43. [PMID: 28405937 DOI: 10.1007/s11886-017-0851-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Echocardiography is the mainstay in the diagnostic evaluation of constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM), but no single echocardiographic parameter is sufficiently robust to accurately distinguish between the two conditions. The present review summarizes the recent advances in echocardiography that promise to improve its diagnostic performance for this purpose. The role of other imaging modalities such as cardiac computed tomography, magnetic resonance imaging, and invasive hemodynamic assessment in the overall diagnostic approach is also discussed briefly. RECENT FINDINGS A recent study has demonstrated improved diagnostic accuracy of echocardiography with integration of multiple conventional echocardiographic parameters in to a step-wise algorithm. Concurrently, the studies using speckle-tracking echocardiography have revealed distinct and disparate patterns of myocardial mechanical abnormalities in CP and RCM with their ability to distinguish between the two conditions. The incorporation of machine-learning algorithms into echocardiography workflow permits easy integration of the wealth of the diagnostic data available and promises to further enhance the diagnostic accuracy of echocardiography. New imaging algorithms are continuously being evolved to permit accurate distinction between CP and RCM. Further research is needed to validate the accuracy of these newer algorithms and to define their place in the overall diagnostic approach for this purpose.
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Affiliation(s)
- Ahmad Mahmoud
- Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt
| | - Manish Bansal
- Heart Institute - Division of Cardiology, Medanta- The Medicity, Gurgaon, India
| | - Partho P Sengupta
- Heart and Vascular Institute, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506, USA.
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Rücklová Z, Marek J, Paleček T, Jeřábek Š, Grus T, Linhart A, Kořínek J. A complicated diagnosis of constrictive pericarditis in a patient with atrial fibrillation - The importance of temporary pacing inducing regular heart rhythm during invasive hemodynamic study. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Transient constrictive pericarditis is increasingly recognized as a distinct sub-type of constrictive pericarditis. The underlying pathophysiology typically relates to impaired pericardial distensibility, associated with acute or sub-acute inflammation, rather than the fibrosis or calcification often seen in chronic pericardial constriction. Accordingly, patients may present clinically with concomitant features of pericarditis and constrictive physiology. Non-invasive multimodality imaging is advocated for diagnosis of transient constrictive pericarditis. Echocardiography remains the mainstay for initial evaluation of the dynamic features of constriction. However, cardiac magnetic resonance imaging can provide complimentary functional information, with the addition of dedicated sequences to assess for active pericardial edema and inflammation. Although transient pericardial constriction can spontaneously resolve, institution of anti-inflammatory therapy may hasten resolution or even prevent progression to chronic pericardial constriction. Non-steroidal anti-inflammatory agents remain the initial treatment of choice, with subsequent consideration of colchicine, steroids, and other immune-modulating agents in more refractory cases.
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Sakurai D, Asanuma T, Masuda K, Koriyama H, Nakatani S. New Parameter Derived from Three-Dimensional Speckle-Tracking Echocardiography for the Estimation of Left Ventricular Filling Pressure in Nondilated Hearts. J Am Soc Echocardiogr 2017; 30:522-531. [PMID: 28325672 DOI: 10.1016/j.echo.2017.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND E/e' is clinically useful for the noninvasive assessment of left ventricular (LV) filling pressure. However, its use in some conditions is controversial, and angle dependence of the Doppler measurement and preload dependence of mitral e' in nondilated hearts represent major problems. The ratio of early filling rate derived from the time derivative of LV volume to early diastolic strain rate (FRe/SRe), similar to E/e', by three-dimensional (3D) speckle-tracking echocardiography has the potential to address such limitations. This study investigated whether FRe/SRe could estimate acute changes in LV filling pressure using the models of volume overload and myocardial ischemia in the nondilated heart. METHODS In 25 dogs, hemodynamic conditions were varied by acute volume overload and coronary occlusion. FRe and SRe were obtained from the same beat and automatically analyzed by the 3D speckle-tracking method, and global SRe was measured from longitudinal (L-SRe), circumferential (C-SRe), and area strain rate (A-SRe). E/e' was measured by two-dimensional echocardiography. LV pressure was derived from a micromanometer catheter and recorded simultaneously with the acquisition of the 3D images. RESULTS Mitral e' and L-SRe varied by changes in preload, whereas C-SRe and A-SRe did not. C-SRe and A-SRe were more strongly correlated with the time constant of LV relaxation than mitral e' and L-SRe. FRe/C-SRe and FRe/A-SRe had relatively high correlations with LV preatrial contraction (pre-A) pressure and end-diastolic pressure, but E/e' and FRe/L-SRe did not. Receiver operating characteristics curve analysis showed that FRe/C-SRe and FRe/A-SRe had larger areas under the curve for the estimation of increased LV filling pressure. CONCLUSIONS The novel parameter FRe/SRe has potential as a surrogate marker of LV filling pressure. Especially in nondilated hearts, FRe/C-SRe and FRe/A-SRe may be useful to more accurately predict LV filling pressure than E/e', although their applicability in dilated hearts requires further investigation.
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Affiliation(s)
- Daisuke Sakurai
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Toshihiko Asanuma
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Kasumi Masuda
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hikaru Koriyama
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Geske JB, Anavekar NS, Nishimura RA, Oh JK, Gersh BJ. Differentiation of Constriction and Restriction. J Am Coll Cardiol 2016; 68:2329-2347. [DOI: 10.1016/j.jacc.2016.08.050] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/04/2016] [Accepted: 08/09/2016] [Indexed: 12/25/2022]
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Imazio M, Pedrotti P, Quattrocchi G, Roghi A, Badano L, Faletti R, Bogaert J, Gaita F. Multimodality imaging of pericardial diseases. J Cardiovasc Med (Hagerstown) 2016; 17:774-82. [DOI: 10.2459/jcm.0000000000000427] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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30
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Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Alexandru Popescu B, Waggoner AD. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2016; 17:1321-1360. [PMID: 27422899 DOI: 10.1093/ehjci/jew082] [Citation(s) in RCA: 1516] [Impact Index Per Article: 189.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
| | | | | | - Benjamin F Byrd
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | | | | | | | | | | | - Jae K Oh
- Mayo Clinic, Rochester, Minnesota
| | - Bogdan Alexandru Popescu
- The University of Medicine and Pharmacy "Carol Davila," Institute of Cardiovascular Diseases, Bucharest, Romania
| | - Alan D Waggoner
- Washington University School of Medicine, St. Louis, Missouri
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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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Patil DV, Sabnis GR, Phadke MS, Lanjewar CP, Mishra P, Kulkarni DV, Agrawal NB, Kerkar PG. Echocardiographic parameters in clinical responders to surgical pericardiectomy - A single center experience with chronic constrictive pericarditis. Indian Heart J 2016; 68:316-24. [PMID: 27316484 PMCID: PMC4912479 DOI: 10.1016/j.ihj.2015.09.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 09/17/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Chronic constrictive pericarditis (CCP) is the end result of chronic inflammation of the pericardium. Developing countries continue to face a significant burden of CCP secondary to tuberculous pericarditis. Surgical pericardiectomy offers potential cure. However, there is paucity of echocardiography data in post-pericardiectomy patients vis-a-vis their clinical status. We studied the changes in multiple echocardiographic parameters in these patients before and after pericardiectomy. METHODS Twenty-three patients (14 men, 9 women) who underwent pericardiectomy for CCP in the last 5 years (from January 2009 to December 2014) were subjected to detailed clinical and echocardiographic evaluation during the study period (between June 2013 and December 2014). Patients with residual symptoms of NYHA class II and below were considered as 'responders'. The data thus obtained were compared to the pre-operative parameters. RESULTS After pericardiectomy, the incidence of vena caval congestion decreased from 100% to 15% (p<0.001). There was significant reduction in the mean left atrial size from 39.33±10.52mm to 34.45±10.08mm (p<0.001) and also the ratio of left atrium to aortic annulus from 1.93 to 1.69 (p<0.001) among 'responders' to pericardiectomy. Septal bounce was observed to persist in 5 (25%) patients after pericardiectomy. There was significant respiratory variation of 39.23±15.11% in the mitral E velocity before pericardiectomy. After pericardiectomy, this variation reduced to 14.43±7.76% (p<0.001). There was also significant reduction in the respiratory variation in tricuspid E velocities from 31.33±18.81% to 17.35±16.26% (p<0.001). After pericardiectomy, the mean ratio of mitral annular velocities, medial e': lateral e', reduced from 1.08 to 0.87 (p<0.03). The phenomenon of 'annulus reversus' was found to persist in 6 'responders', thereby reflecting a 50% reduction in its incidence after pericardiectomy (p<0.001). The ratio of mitral E to medial e' (E/e') increased from 4.21±1.35 before pericardiectomy to 6.91±2.62 after pericardiectomy (p=0.001). CONCLUSION Among clinical responders to surgical pericardiectomy, echocardiographic assessment revealed a significant reduction in vena caval congestion, LA size, ratio of LA to aortic annulus, septal bounce, respiratory variation in mitral and tricuspid E velocities, mitral annular medial e' and the phenomenon of annulus reversus. Also, there was a significant rise in minimum tricuspid and mitral E velocities and the E/e' ratio.
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Affiliation(s)
- Devendra V Patil
- Department of Cardiology, Seth G.S. Medical College and King Edward VII Memorial Hospital, Mumbai, India.
| | - Girish R Sabnis
- Department of Cardiology, Seth G.S. Medical College and King Edward VII Memorial Hospital, Mumbai, India
| | - Milind S Phadke
- Department of Cardiology, Seth G.S. Medical College and King Edward VII Memorial Hospital, Mumbai, India
| | - Charan P Lanjewar
- Department of Cardiology, Seth G.S. Medical College and King Edward VII Memorial Hospital, Mumbai, India
| | - Prashant Mishra
- Department of Cardiovascular and Thoracic Surgery, Seth G.S. Medical College and King Edward VII Memorial Hospital, Mumbai, India
| | - Dwarkanath V Kulkarni
- Department of Cardiovascular and Thoracic Surgery, Seth G.S. Medical College and King Edward VII Memorial Hospital, Mumbai, India
| | - Nandkishor B Agrawal
- Department of Cardiovascular and Thoracic Surgery, Seth G.S. Medical College and King Edward VII Memorial Hospital, Mumbai, India
| | - Prafulla G Kerkar
- Department of Cardiology, Seth G.S. Medical College and King Edward VII Memorial Hospital, Mumbai, India
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Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Popescu BA, Waggoner AD. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2016; 29:277-314. [PMID: 27037982 DOI: 10.1016/j.echo.2016.01.011] [Citation(s) in RCA: 3254] [Impact Index Per Article: 406.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | - Benjamin F Byrd
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | | | | | | | | | | | - Jae K Oh
- Mayo Clinic, Rochester, Minnesota
| | - Bogdan Alexandru Popescu
- University of Medicine and Pharmacy "Carol Davila," Institute of Cardiovascular Diseases, Bucharest, Romania
| | - Alan D Waggoner
- Washington University School of Medicine, St. Louis, Missouri
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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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Regional left atrial function differentiation in patients with constrictive pericarditis and restrictive cardiomyopathy: a study using speckle tracking echocardiography. Int J Cardiovasc Imaging 2015; 31:1529-36. [DOI: 10.1007/s10554-015-0726-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/25/2015] [Indexed: 12/27/2022]
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Lei J, Dhamoon AS, Wang J, Iannuzzi M, Liu K. Walking the tightrope: Using quantitative Doppler echocardiography to optimize ventricular filling pressures in patients hospitalized for acute heart failure. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 5:130-40. [PMID: 25694508 DOI: 10.1177/2048872615573517] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/28/2015] [Indexed: 01/03/2023]
Affiliation(s)
- Juan Lei
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, China
| | - Amit S Dhamoon
- Department of Medicine, State University of New York, USA
| | - Jingfeng Wang
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, China
| | | | - Kan Liu
- Department of Medicine, State University of New York, USA
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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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Assessment of Ventricular-Vascular Function by Echocardiography. CONGENIT HEART DIS 2015. [DOI: 10.1007/978-4-431-54355-8_7] [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: 10/24/2022]
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Impact of Inodilator Drugs on Echocardiographic Assessments of Left Ventricular Filling Pressure in Patients With Decompensated End-Stage Heart Failure*. Crit Care Med 2014; 42:2508-17. [DOI: 10.1097/ccm.0000000000000513] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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40
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Angheloiu GO, Rayarao G, Williams R, Yamrozik J, Doyle M, Biederman RWW. Magnetic resonance characterization of septal bounce: findings of blood impact physiology. Int J Cardiovasc Imaging 2014; 31:105-13. [DOI: 10.1007/s10554-014-0537-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 09/10/2014] [Indexed: 11/30/2022]
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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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Global endocardial area change rate for the assessment of left ventricular relaxation and filling pressure: using 3-dimensional speckle-tracking study. Int J Cardiovasc Imaging 2014; 30:1473-81. [PMID: 25022429 DOI: 10.1007/s10554-014-0486-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 07/02/2014] [Indexed: 10/25/2022]
Abstract
Early diastolic mitral inflow and annulus velocities ratio (E/e') is the parameter used to estimate left ventricular (LV) filling pressure, but their use for patients with reduced ejection fraction (EF) (<50 %) is controversial. LV endocardial area change rate with 3-dimensional (3-D) speckle-tracking can be used to evaluate the entire LV diastolic function, we tested the hypothesis that the early diastolic area change rate (E-ACR) represents LV relaxation, and E and E-ACR ratio (E/E-ACR) can accurately predict LV filling pressure in patients with reduced and preserved EF (≥50 %). We studied 125 patients with EF of 40 ± 17 %. E-ACR of all patients was measured using the global area change rate, and LV relaxation time constant (τ, n = 53) and pulmonary capillary wedge pressure (PCWP, n = 125) were measured by cardiac catheterization. E-ACR significantly correlated with τ (r = -0.60, p < 0.001). In the retrospective group (n = 101), E/E-ACR correlated with PCWP for patients with reduced EF as well as those with preserved EF (n = 79 and 22, r = 0.62 and 0.81, both p < 0.001). In overall patients, E/E-ACR ≥94 cm was a better predictor of elevated mean PCWP (>12 mmHg) (sensitivity: 69 %, specificity: 87 %, areas under the curves = 0.82; p < 0.001) and was a more accurate predictor than E/e' (p = 0.001) for the retrospective group. For the validation group (n = 24), E/E-ACR ≥94 cm was similarly predictive for elevated mean PCWP (sensitivity: 60 %, specificity: 100 %, positive predictive value: 100 %, negative predictive value: 78 %). In conclusions, global E-ACR by 3-D speckle-tracking proved to be dependent on LV relaxation. Moreover, E/E-ACR was found to be a powerful predictor of LV filling pressure regardless of EF.
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Cameli M, Bigio E, Lisi M, Righini FM, Galderisi M, Franchi F, Scolletta S, Mondillo S. Relationship between pulse pressure variation and echocardiographic indices of left ventricular filling pressure in critically ill patients. Clin Physiol Funct Imaging 2014; 35:344-50. [PMID: 24902871 DOI: 10.1111/cpf.12168] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 04/28/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pulse pressure variation (PPV) is a dynamic index of fluid responsiveness. This parameter helps clinicians in improving haemodynamic status while avoiding potential fluid overload. Echocardiographic indices, such as E/E' ratio and left atrial (LA) strain by speckle tracking echocardiography (STE), are used to estimate left ventricular (LV) filling pressures. This study aimed at exploring the relationship between PPV and echocardiographic indices of LV filling pressures in critically ill patients. METHODS Twenty-two patients (mean age of 50.9 ± 21.6, male/female = 15/7) admitted to intensive care unit, and requiring mechanical ventilation and invasive arterial pressure monitoring, were studied. In all patients, two independent operators assessed simultaneously PPV, using a pulse contour method, mean E/E' ratio and peak atrial longitudinal strain (PALS) by means of STE. PALS values were obtained by averaging LA segments measured in the 4-chamber and 2-chamber views (global PALS). RESULTS A significant negative correlation was found between mean E/E' ratio and PPV (R(2) = -0.76; P<0.001). A positive correlation between global PALS and PPV was found (R(2) = 0.80, P<0.001). Mean global PALS of 26.2% demonstrated excellent accuracy (Area Under Roc Curve = 0.86, P<0.001), and good sensitivity (92%) and specificity (86%) in predicting a PPV >15%. CONCLUSION In a group of mechanically ventilated patients PPV, derived from pulse contour analysis, and echocardiographic preload parameters were well correlated. Global PALS by STE provided better estimation of PPV than mean E/E' ratio. PALS seems a potential alternative to PPV in assessing fluid responsiveness in critically ill patients.
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Affiliation(s)
- Matteo Cameli
- Department of Medical Biotechnologies, University of Siena, Italy.,Unit of Cardiovascular Diseases, University of Siena, Italy
| | - Elisa Bigio
- Department of Medical Biotechnologies, University of Siena, Italy.,Unit of Anesthesia and Intensive Care Unit, University of Siena, Italy
| | - Matteo Lisi
- Department of Medical Biotechnologies, University of Siena, Italy.,Unit of Cardiovascular Diseases, University of Siena, Italy
| | - Francesca M Righini
- Department of Medical Biotechnologies, University of Siena, Italy.,Unit of Cardiovascular Diseases, University of Siena, Italy
| | - Maurizio Galderisi
- Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Federico Franchi
- Department of Medical Biotechnologies, University of Siena, Italy.,Unit of Anesthesia and Intensive Care Unit, University of Siena, Italy
| | - Sabino Scolletta
- Department of Medical Biotechnologies, University of Siena, Italy.,Unit of Anesthesia and Intensive Care Unit, University of Siena, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, University of Siena, Italy.,Unit of Cardiovascular Diseases, University of Siena, Italy
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Alraies MC, Kusunose K, Negishi K, Yarmohammadi H, Motoki H, AlJaroudi W, Popović ZB, Klein AL. Relation between echocardiographically estimated and invasively measured filling pressures in constrictive pericarditis. Am J Cardiol 2014; 113:1911-6. [PMID: 24837273 DOI: 10.1016/j.amjcard.2014.03.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/05/2014] [Accepted: 03/05/2014] [Indexed: 11/28/2022]
Abstract
The ratio of early transmitral flow velocity (E) to mitral annular velocity (E') is considered a predictor of pulmonary capillary wedge pressure (PCWP). In a previous small study, the paradoxical relation between PCWP and E/E' ratio has been described in patients with constrictive pericarditis (CP). We sought to test this paradoxical relation in a larger cohort. We retrospectively identified 49 patients with surgically confirmed CP (40 men; mean age 61 ± 10 years) who underwent right-sided cardiac catheterization with PCWP measurement, preceded by an echocardiographic study. Of these, 48 patients underwent either computed tomography or magnetic resonance imaging to measure pericardial thickness on the lateral side of the left ventricular wall. Mean interval time between echocardiogram and right-sided cardiac catheterization was 1.5 ± 3.8 days. There were no significant correlations between mean, medial, or lateral E/E' and PCWP (r = -0.17, 95% confidence interval [CI] -0.43 to -0.12; r = -0.17, 95% CI -0.43 to -0.12; and r = -0.12, 95% CI -0.39 to -0.17, respectively). Similarly, there was no correlation between mean E/E' and brain natriuretic peptide (Spearman r = -0.17, p = NS). Patients with increased pericardial thickness (defined as >4 mm) had both lower lateral peak systolic annular velocity (S') and lower lateral S' integral (7.8 ± 2.4 vs 9.6 ± 2.4, p = 0.02 and 13.2 ± 4.2 vs 15.9 ± 4.7, p = 0.04, respectively). In patients with CP, there were no correlations between septal, lateral, or mean E/E' and PCWP. In conclusion, E/E' is not predictive of filling pressures in patients with CP, and perhaps the "annulus paradoxus" phenomenon should be revisited. The relation between the mitral annular velocity and thickness of the parietal pericardium may affect this phenomenon.
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Affiliation(s)
- M Chadi Alraies
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kazuaki Negishi
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hirad Yarmohammadi
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Wael AlJaroudi
- Division of Cardiovascular Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zoran B Popović
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Allan L Klein
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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The use ofE/Em and the time interval difference of isovolumic relaxation (TIVRT−IVRTm) in estimating left ventricular filling pressures. Eur J Heart Fail 2014; 10:490-7. [DOI: 10.1016/j.ejheart.2008.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 01/15/2008] [Accepted: 03/10/2008] [Indexed: 11/19/2022] Open
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Yingchoncharoen T, Alraies MC, Kwon DH, Rodriguez ER, Tan CD, Klein AL. Emerging role of multimodality imaging in management of inflammatory pericardial diseases. Expert Rev Cardiovasc Ther 2014; 11:1211-25. [DOI: 10.1586/14779072.2013.832624] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Klein AL, Abbara S, Agler DA, Appleton CP, Asher CR, Hoit B, Hung J, Garcia MJ, Kronzon I, Oh JK, Rodriguez ER, Schaff HV, Schoenhagen P, Tan CD, White RD. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2013; 26:965-1012.e15. [PMID: 23998693 DOI: 10.1016/j.echo.2013.06.023] [Citation(s) in RCA: 402] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Liu S, Ma C, Ren W, Yang J, Zhang Y, Li S, Cheng Y. Left Atrial Systolic and Diastolic Dysfunction in Patients with Chronic Constrictive Pericarditis: A Study Using Speckle Tracking and Conventional Echocardiography. PLoS One 2013; 8:e68718. [PMID: 23825701 PMCID: PMC3689000 DOI: 10.1371/journal.pone.0068718] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 05/31/2013] [Indexed: 11/18/2022] Open
Abstract
Background Left atrial (LA) function plays an important role in the maintenance of cardiac output, however, in patients with constrictive pericarditis (CP), whether pericardial restriction and adhesion can lead to LA dysfunction, and the characteristics of LA function remain unclear. The aim of the study is to compare the left atrial (LA) function of patients with CP to that of healthy study participants using speckle tracking echocardiography (STE) and conventional echocardiography. Methods and Results Thirty patients with CP and 30 healthy volunteers (controls) were enrolled in the study. The underlying cause of CP was viral pericarditis in 24 (80%) patients and unknown in 6 (20%) patients. The LA maximum volume (Vmax), LA minimal volume (Vmin), and LA volume before atrial contraction (Vpre-a) were measured using biplane modified Simpson’s method. The LA expansion index (LA reservoir function) was determined as follows: ([LAVmax - LAVmin]/LAVmin) ×100. The passive emptying index (LA conduit function) was calculated as follows: ([LAVmax - LAVpre-a]/LAVmax) ×100, and the active emptying index (booster pump function) was calculated as follows: ([LAVpre-a - LAVmin]/LAVpre-a) ×100. All the patients underwent two-dimensional STE. The LA global systolic strain (S), systolic strain rate (SrS), early diastolic strain rate (SrE) and late diastolic strain rate (SrA) were measured. The LA expansion index, passive emptying index, the active emptying index and the LA global S, SrS, SrE, SrA were found to be significantly lower in patients with CP than in the control participants (P <0.001). LA function was correlated with the early diastolic velocity of the lateral mitral annulus (P <0.05). Conclusions Although left ventricular systolic function was preserved in patients with CP, the LA reservoir, conduit, and booster functions were impaired. Pericardial restriction and impairment of the LA myocardium may play an important role in the reduction of LA function in patients with CP.
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Affiliation(s)
- Shuang Liu
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
- Department of Cardiovascular Function, First Affiliated Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Chunyan Ma
- Department of Cardiovascular Function, First Affiliated Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
- * E-mail:
| | - Jun Yang
- Department of Cardiovascular Function, First Affiliated Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Yan Zhang
- Department of Cardiovascular Function, First Affiliated Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Sha Li
- Department of Cardiovascular Function, First Affiliated Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Yanbin Cheng
- Department of Cardiovascular Function, First Affiliated Hospital of China Medical University, Shenyang, People’s Republic of China
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Motoki H, Alraies MC, Dahiya A, Saraiva RM, Hanna M, Marwick TH, Klein AL. Changes in left atrial mechanics following pericardiectomy for pericardial constriction. J Am Soc Echocardiogr 2013; 26:640-8. [PMID: 23562086 DOI: 10.1016/j.echo.2013.02.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although impaired left ventricular (LV) filling in constrictive pericarditis (CP) is attributable to external constraints by a tethered pericardium, impaired left atrial (LA) function can further impair LV filling. Previous studies focused on the impact of a tethered pericardium on LV diastolic behavior, but its impact on LA function has been largely overlooked. The objectives of this study were to evaluate LA mechanics in CP and to assess the impact of pericardiectomy on LA mechanics. METHODS A total of 52 patients with CP (mean age, 57 ± 12 years) and 19 control subjects were studied retrospectively. All patients with CP underwent echocardiography before (median, 12 days; interquartile range, 5-34 days) and after pericardiectomy (median, 20 days; interquartile range, 5-64 days). Global LA longitudinal strain (ε) was calculated, which included peak negative ε (εnegative), peak positive ε (εpositive), and the sum of those values, total LA ε (εtotal), using speckle-tracking echocardiography with Velocity Vector Imaging. The regional difference of LA ε between the septal and lateral walls was assessed before and after the procedure. RESULTS Patients with CP showed depressed global LA εnegative, LA εtotal, and LA εpositive compared with controls. LA contractile (global LA εnegative) and reservoir functions (global LA εtotal) showed significant increases after pericardiectomy. Regional analysis revealed that the improvement in LA function after surgery was more apparent in lateral segments, while the regional function of septal walls was depressed after surgery. CONCLUSIONS Patients with CP have impaired LA mechanics, presumably because of the constrictive tethering process involving the left atrium. Speckle-tracking echocardiography showed consistent results of changes in LA mechanics with conventional echocardiographic parameters early after the procedure. Regional ε analysis aided in recognition of the impact of constrictive tethering and pericardiectomy on LA function.
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Affiliation(s)
- Hirohiko Motoki
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Anavekar NS, Wong BF, Foley TA, Bishu K, Kolipaka A, Koo CW, Khandaker MH, Oh JK, Young PM. Index of biventricular interdependence calculated using cardiac MRI: a proof of concept study in patients with and without constrictive pericarditis. Int J Cardiovasc Imaging 2012; 29:363-9. [DOI: 10.1007/s10554-012-0101-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 07/12/2012] [Indexed: 11/28/2022]
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