1176 Echocardiographic indices and NT-proBNP levels in pericardial effusion, constrictive pericarditis and endomyocardial fibrosis

Background Patients with recurrent pericarditis (RP) may develop complications, multiple recurrences, or inadequate treatment response. This study aimed to characterize disease burden and unmet needs in RP. Methods and Results This retrospective US database analysis included newly diagnosed patients with RP with ≥24 months of continuous history following their first pericarditis episode. RP was defined as ≥2 pericarditis episodes ≥28 days apart. Some patients had ≥2 recurrences, while others had a single recurrence with a serious complication, ie, constrictive pericarditis, cardiac tamponade, or a large pericardial effusion with pericardiocentesis/pericardial window. Among these patients with multiple recurrences and/or complications, some had features relating to treatment history, including long‐term corticosteroid use (corticosteroids started within 30 days of flare, continuing ≥90 consecutive days) or inadequate treatment response (pericarditis recurring despite corticosteroids and/or colchicine, or other drugs [excluding NSAIDs] within 30 days of flare, or prior pericardiectomy). Patients (N=2096) had hypertension (60%), cardiomegaly (9%), congestive heart failure (17%), atrial fibrillation (16%), autoimmune diseases (18%), diabetes mellitus (21%), renal disease (20%), anxiety (21%), and depression (14%). Complications included pericardial effusion (50%), cardiac tamponade (9%), and constrictive pericarditis (4%). Pharmacotherapy included colchicine (51%), NSAIDs (40%), and corticosteroids (30%), often in combination. This study estimates 37 000 US patients with RP; incidence was 6.0/100 000/year (95% CI, 5.6‒6.3), and prevalence was 11.2/100 000 (95% CI, 10.6‒11.7). Conclusions Patients with RP may have multiple recurrences and/or complications, often because of inadequate treatment response and persistent underlying disease. Corticosteroid use is frequent despite known side‐effect risks, potentially exacerbated by prevalent comorbidities. Substantial clinical burden and lack of effective treatments underscore the high unmet need.

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Lipomatous Hypertrophy of Interatrial Septum Presenting as Recurring Pericardial Effusion and Mistaken for Constrictive Pericarditis

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0028-1096286 ◽

1979 ◽

Vol 27 (06) ◽

pp. 400-403 ◽

Cited By ~ 13

Author(s):

A. Tschirkov ◽

B. Stegaru

Keyword(s):

Pericardial Effusion ◽

Constrictive Pericarditis ◽

Interatrial Septum ◽

Lipomatous Hypertrophy

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Diseases of the Pericardium, Cardiac Tumors, and Cardiac Trauma

10.2310/7900.1025 ◽

2016 ◽

Author(s):

Terrence D. Welch ◽

Kyle W Klarich ◽

Jae K. Oh

Keyword(s):

Pericardial Effusion ◽

Constrictive Pericarditis ◽

Restrictive Cardiomyopathy ◽

Left Ventricular ◽

Cardiac Tumors ◽

Management Options ◽

Acute Pericarditis ◽

Pericardial Disease ◽

Cardiac Trauma ◽

Pulsed Wave Doppler

The pericardium consists of a fibrous sac and a serous membrane. Because of its simple structure, the clinical syndromes involving the pericardium are relatively few but vary substantially in severity. Cardiac tumors may be either primary or secondary and either benign or malignant, with attachment sites throughout the endocardium. Cardiovascular trauma should be suspected in all patients with chest injuries or severe generalized trauma. Cardiovascular injury may be either blunt or penetrating. This review covers pericardial disease, cardiac tumors, and cardiovascular trauma. Figures show an electrocardiogram in acute pericarditis; acute pericarditis with delayed gadolinium enhancement of the pericardium shown with cardiac magnetic resonance imaging; underlying cause of pericardial effusion requiring pericardiocentesis; pericardial pressure-volume curves; large pericardial effusion with swinging motion of the heart resulting in electrical alternans; typical pulsed-wave Doppler pattern of tamponade; underlying causes of constrictive pericarditis in patients undergoing pericardiectomy; pericardial calcification seen on a chest radiograph; thickened pericardium; typical pulsed-wave Doppler pattern of constrictive pericarditis; typical mitral annular tissue velocities in constrictive pericarditis; a diagnostic algorithm for the echocardiographic diagnosis of constrictive pericarditis; simultaneous right ventricular and left ventricular pressure tracings in restrictive cardiomyopathy; computed tomographic scan showing inflammatory constrictive pericarditis; systolic and diastolic transesophageal echocardiographic images of a large left atrial myxoma attached to the atrial septum; a decision tree of management options for patients with suspected papillary; transesophageal echocardiographic examples of aortic valve, mitral valve, left ventricular outflow tract, and tricuspid valve papillary fibroelastomas; and transesophageal short-axis view of the descending thoracic aorta in a hypotensive patient after a motor vehicle accident. The table lists tamponade versus constriction versus restrictive cardiomyopathy. This review contains 18 highly rendered figures, 1 table, and 77 references.

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The pericardium and pericardial disease

Practical Perioperative Transoesophageal Echocardiography ◽

10.1093/med/9780198759089.003.0016 ◽

2018 ◽

Author(s):

David Sidebotham ◽

Alan Merry ◽

Malcolm Legget ◽

Gavin Wright

Keyword(s):

Pericardial Effusion ◽

Constrictive Pericarditis ◽

Restrictive Cardiomyopathy ◽

Transoesophageal Echocardiography ◽

Pericardial Tamponade ◽

Acute Pericarditis ◽

Pericardial Disease ◽

Mechanically Ventilated ◽

Spectral Doppler ◽

Echocardiographic Assessment

Chapter 16 is a new chapter from earlier editions of Practical Perioperative Transoesophageal Echocardiography. It provides a short summary on the echocardiographic assessment of the normal pericardium and on pericardial disease. The characteristic TOE features of pericardial pathology (cysts, acute pericarditis, pericardial effusion, pericardial tamponade, and constrictive pericarditis) are reviewed. In particular, pericardial constriction is discussed in detail, including outlining the features that distinguish pericardial constriction from restrictive cardiomyopathy. Wherever possible, the spectral Doppler abnormalities associated with pericardial constriction and pericardial tamponade are discussed with reference to patients who are mechanically ventilated.

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1095 Effective image-guided medical management in effusive constrictive pericarditis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.646 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

A Montes ◽

A Cecconi ◽

T Alvarado ◽

A Vera ◽

A Barrios ◽

...

Keyword(s):

Pericardial Effusion ◽

Medical Treatment ◽

Constrictive Pericarditis ◽

Pericardial Fluid ◽

Pericardial Window ◽

Acute Pericarditis ◽

Intravenous Corticosteroid ◽

Persistent Inflammation ◽

High Doses ◽

Effusive Constrictive Pericarditis

Abstract A 59 year old man was admited to hospitalization for persistent chest pain related to acute pericarditis. Within the admision tests, a transthoracic echography was performed, showing a moderate pericardial effusion with ventricular septal bounce and significant respiratory variations in mitral and tricuspid inflows, all of it consistent with effusive-constrictive pericarditis (Panel A). Anti-inflammatory treatment with ibuprofen and colchicine was started. During the first 48 hours of admission there was a clinical and hemodinamic worsening in the patient’s condition that forced the performance of a pericardial window, obtaining a very little quantity of dense pericardial fluid. Looking for a more accurate study of the pericardium, a cardiovascular magnetic resonance (CMR) was performed, revealing a thick heterogeneous pericardial effusion (Panel B) and a significant late gadolinium enhancement of both pericardial layers (Panel C). All these findings where consistent with an effusive constrictive pericarditis with persistent inflammatory activity despite high doses of conventional inflammatory treatment. Furthermore, the growth of Propionibacterium acnes in the pericardial fluid disclosed the etiology of this condition. Medical treatment was enhanced with high doses of intravenous corticosteroid, ceftriaxone and doxycycline. During the following days, the patient showed an excellent response achieving the complete clinical and echocardiographic relief of constrictive signs (Panel D). Effusive constrictive pericarditis is characterized by the presence of pericardial effusion and constriction secondary to an inflammatory process of the pericardium. Pericardiectomy might be necessary in case of failure of medical treatment, a very common scenario in this kind of .pericarditis. Our case is remarkable because it demonstrates the value of CMR to detect persistent inflammation of pericardium despite high doses of conventional medical treatment for pericaricarditis guiding the successful escalation to intravenous corticosteroid and avoiding the risk of an unnecessary cardiac surgery. Abstract 1095 Figure.

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Chronic Pericardial Effusion Complicating Endomyocardial Fibrosis

Circulation ◽

10.1161/01.cir.28.2.221 ◽

1963 ◽

Vol 28 (2) ◽

pp. 221-231 ◽

Cited By ~ 7

Author(s):

D. GORDON ABRAHAMS ◽

E. H. O. PARRY

Keyword(s):

Pericardial Effusion ◽

Endomyocardial Fibrosis

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639 A case of acute transient constrictive pericarditis—an unusual presentation

European Heart Journal Supplements ◽

10.1093/eurheartj/suab142.052 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Paolo Marco Pietro Spissu ◽

Simone Angius ◽

Maria Francesca Marchetti ◽

Ludovica Caggiari ◽

Alessandra Gioi ◽

...

Keyword(s):

Pericardial Effusion ◽

Constrictive Pericarditis ◽

Vena Cava ◽

Tissue Doppler ◽

Doppler Imaging ◽

Acute Pericarditis ◽

Echocardiographic Examination ◽

Mild Reduction ◽

Chest X Ray ◽

Anti Inflammatory

Abstract Aims Transient constrictive pericarditis (TCP) is a rare manifestation which can occur in up to 15% of cases of acute pericarditis and most have resolution after 3 months of anti-inflammatory therapy. Methods and results We present the case of a young guy who showed up at our emergency department complaining of pericarditic chest pain and fever up to 39 °C degrees since the previous 4 days. After physical examination, electrocardiogram, blood tests, chest X-ray, and echocardiography acute pericarditis with severe pericardial effusion (more than 20 mm of thickness) were diagnosed and an empiric anti-inflammatory therapy with ibuprofen and colchicine was started. After 2 weeks of therapy, patient was not clinically improving with a worsened pericardial effusion and only a mild reduction of inflammatory markers. During an echocardiographic examination, features of constrictive physiology were discovered: respirophasic interventricular septal shift, increased respiratory variation of the mitral and tricuspidal inflow, plethoric inferior vena cava, and ‘annulus reversus’ and ‘annulus paradoxus’ on Tissue Doppler Imaging (TDI). Cardiac magnetic resonance (CMR) was also performed to confirm the diagnosis of acute pericardial constriction: it revealed increased T2-weighted imaging signal and increased Delayed Gadolinium Enhanced (DGE) signal, respectively consistent with oedema and with neovascularization, both suggestive of acute pericardial inflammation. Therefore, oral low doses corticosteroid was started After 2 weeks course of ‘triple therapy’ the patient was clinically improved and the echocardiographic features of constrictive physiology were no longer present thus allowing his discharge and the continuation of therapy at home. Conclusions This case was remarkable because it showed that constrictive pericarditis may present in a reversible form with medical therapy, this meaning it is due to pericardial oedema, inflammation and fibrin deposition similar to acute pericarditis rather than the pericardial fibrosis and calcification more commonly seen in chronic pericardial constriction.

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A Case of Diffuse Endomyocardial Fibrosis of the Right Ventricle with Persistent Pericardial Effusion

Japanese Heart Journal ◽

10.1536/ihj.17.774 ◽

1976 ◽

Vol 17 (6) ◽

pp. 774-783

Author(s):

Sukenobu ITO ◽

Morio ITO ◽

Takehiko FUJINO ◽

Teruo FUKUMOTO ◽

Syozo KANAYA ◽

...

Keyword(s):

Pericardial Effusion ◽

Right Ventricle ◽

Endomyocardial Fibrosis ◽

The Right

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Pericardial disease

10.1093/med/9780198726012.003.0049 ◽

2016 ◽

Author(s):

Bernard Paelinck ◽

Aleksandar Lazarević ◽

Pedro Gutierrez Fajardo

Keyword(s):

Differential Diagnosis ◽

Pleural Effusion ◽

Pericardial Effusion ◽

Constrictive Pericarditis ◽

Restrictive Cardiomyopathy ◽

Tissue Doppler ◽

Doppler Imaging ◽

Two Dimensional ◽

Pericardial Disease ◽

Pericardial Diseases

Echocardiography is the cornerstone for the diagnosis of pericardial disease. It is a portable technique allowing morphological and functional multimodality (M-mode, two-dimensional, Doppler, and tissue Doppler) imaging of pericardial disease. In addition, echocardiography is essential for differential diagnosis (pericardial effusion vs pleural effusion, constrictive pericarditis vs restrictive cardiomyopathy) and allows bedside guiding of pericardiocentesis. This chapter describes normal pericardial anatomy and reviews echocardiographic features of different pericardial diseases and their pathophysiology, including pericarditis, pericardial effusion, constrictive pericarditis, pericardial cyst, and congenital absence of pericardium.

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