Improvement in left ventricular mechanics following medical treatment of constrictive pericarditis
- 6 January 2021
- Vol. 107 (10), 828-835
- https://doi.org/10.1136/heartjnl-2020-317304
Abstract
Objective Patients with constrictive pericarditis (CP) with active inflammation may show resolution with anti-inflammatory therapy. We aimed to investigate the impact of anti-inflammatory medications on constrictive pathophysiology using echocardiography in patients with CP. Methods We identified 35 patients with CP who were treated with anti-inflammatory medications (colchicine, prednisone, non-steroidal anti-inflammatory drugs) after diagnosis of CP (mean age 58±13; 80% male). Clinical resolution of CP (transient CP) was defined as improvement in New York Heart Association class during follow-up. We assessed constrictive pathophysiology using regional myocardial mechanics by the ratio of peak early diastolic tissue velocity (e’) at the lateral and septal mitral annulus by tissue Doppler imaging (lateral/septal e’) or the ratio of the left ventricular lateral and septal wall longitudinal strain (LSlateral/LSseptal) by two-dimensional speckle-tracking echocardiography. Longitudinal data were analysed using a mixed effects model. Results During a median follow-up of 323 days, 20 patients had transient CP, whereas 15 patients had persistent CP. Transient CP had higher baseline erythrocyte sedimentation rates (ESR) (p=0.003) compared with persistent CP. There were no significant differences in LSlateral/LSseptal and lateral/septal e’. During follow-up, only transient CP showed improvement in lateral/septal e’ (plateral/LSseptal (p=0.003), and recovery of inflammatory markers was similar between the two groups. In the logistic model, higher baseline ESR and greater improvement in lateral/septal e’ and LSlateral/LSseptal were associated with clinical resolution of CP using anti-inflammatory therapy. Conclusions Improvement of constrictive physiology detected by lateral/septal e’ and LSlateral/LSseptal was associated with resolution of clinical symptoms after anti-inflammatory treatment. Serial monitoring of these markers could be used to identify transient CP.Keywords
This publication has 45 references indexed in Scilit:
- Mortality and Sudden Death in Pediatric Left Ventricular Noncompaction in a Tertiary Referral CenterCirculation, 2013
- Biventricular Mechanics in Constrictive Pericarditis Comparison With Restrictive Cardiomyopathy and Impact of PericardiectomyCirculation: Cardiovascular Imaging, 2013
- Pericardial Delayed Hyperenhancement With CMR Imaging in Patients With Constrictive Pericarditis Undergoing Surgical Pericardiectomy: A Case Series With Histopathological CorrelationJACC: Cardiovascular Imaging, 2011
- PredictABEL: an R package for the assessment of risk prediction modelsEuropean Journal of Epidemiology, 2011
- Extensions of net reclassification improvement calculations to measure usefulness of new biomarkersStatistics in Medicine, 2010
- Isolated Left Ventricular Noncompaction SyndromeThe American Journal of Cardiology, 2009
- Classification of the cardiomyopathies: a position statement from the european society of cardiology working group on myocardial and pericardial diseasesEuropean Heart Journal, 2007
- Constrictive pericarditis: A reminder of a not so rare diseaseEuropean Journal of Internal Medicine, 2006
- Differentiation of constrictive pericarditis from restrictive cardiomyopathy using mitral annular velocity by tissue Doppler echocardiographyThe American Journal of Cardiology, 2004
- Transient cardiac constriction: an unrecognized pattern of evolution in effusive acute idiopathic pericarditisThe American Journal of Cardiology, 1987