Quantitative Assessment of Pericardial Delayed Hyperenhancement Predicts Clinical Improvement in Patients With Constrictive Pericarditis Treated With Anti-Inflammatory Therapy

Introduction: Reversible constrictive pericarditis (CP) has been described with resolution of constriction after treatment with anti-inflammatory medications. In our study, we assessed the improvement of biventricular myocardial strain in CP patients treated medically compared to CP patients who underwent pericardiectomy. Methods and Results: We compared myocardial mechanics by 2-dimensional speckle tracking in 16 CP patients (age: 56±13; 75% males) who received anti-inflammatory medications to an age and sex matched CP group (age: 57±12; 75% males) who underwent pericardiectomy. At baseline, both treatment groups had depressed left ventricular (LV) anterolateral wall strain (LWS) and right ventricular (RV) free wall longitudinal systolic strain (FWS) but preserved LV septal wall systolic strain (SWS). In a median follow-up of 150 days the medically treated patients showed improvement of the depressed LVLWS/LVSWS (Pre: 0.61±0.17, Post: 0.89±0.21;P<0.001) and a trend in RVFWS/LVSWS (Pre:0.66±0.45, Post:0.89±0.38;P=0.12), that is similar to the improvement of the depressed LVLWS/LVSWS (Pre: 0.85±0.12, Post: 0.92±0.1;P<0.05) and trend in RVFWS/LVSWS (Pre: 0.77±0.32, Post: 0.86±0.18;P=0.09) of post pericardiectomy patients at a median follow-up of 74 days. Conclusions: Biventricular myocardial strain imaging is a robust technique for assessment of response to anti-inflammatory therapy in CP patients. Medical treatment of CP leads to systolic strain improvement that is more pronounced in the LV and RV free walls, hence having similar impact on the biventricular myocardial mechanics as pericardiectomy.

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Improvement in left ventricular mechanics following medical treatment of constrictive pericarditis

Heart ◽

10.1136/heartjnl-2020-317304 ◽

2021 ◽

pp. heartjnl-2020-317304

Author(s):

Kimi Sato ◽

Ayman Ayache ◽

Arnav Kumar ◽

Paul C Cremer ◽

Brian Griffin ◽

...

Keyword(s):

Constrictive Pericarditis ◽

Clinical Symptoms ◽

Heart Association ◽

Left Ventricular ◽

Doppler Imaging ◽

Clinical Resolution ◽

Ventricular Mechanics ◽

Anti Inflammatory ◽

The Impact

ObjectivePatients 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.MethodsWe 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.ResultsDuring 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’ (p<0.001) and LSlateral/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.ConclusionsImprovement 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.

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Quantitative assessment of non-steroidal anti-inflammatory topical products in nicotinate-induced erythema using tristimulus colour analysis

International Journal of Pharmaceutics ◽

10.1016/0378-5173(82)90010-2 ◽

1992 ◽

Vol 83 (1-3) ◽

pp. 73-86 ◽

Cited By ~ 13

Author(s):

Sui Yung Chan ◽

Alain Li Wan Po

Keyword(s):

Quantitative Assessment ◽

Anti Inflammatory

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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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P694Higher inflammation and recovery of tissue Doppler velocity ratio predicts resolution of constrictive pericarditis by anti-inflammatory medications

European Heart Journal ◽

10.1093/eurheartj/ehy564.p694 ◽

2018 ◽

Vol 39 (suppl_1) ◽

Author(s):

K Sato ◽

A Kumar ◽

C Ala ◽

K Ahuja ◽

B Verma ◽

...

Keyword(s):

Constrictive Pericarditis ◽

Velocity Ratio ◽

Tissue Doppler ◽

Doppler Velocity ◽

Anti Inflammatory

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Diftalone: A New Non-Steroidal Anti-Inflammatory Agent: Comparative Study with Phenylbutazone in the Treatment of Rheumatoid Arthritis

Journal of International Medical Research ◽

10.1177/030006057700500103 ◽

1977 ◽

Vol 5 (1) ◽

pp. 18-25 ◽

Cited By ~ 10

Author(s):

F Chalem ◽

P Farias ◽

H Lizarazo ◽

P Peña

Keyword(s):

Rheumatoid Arthritis ◽

Side Effects ◽

Comparative Study ◽

Clinical Improvement ◽

Laboratory Tests ◽

Double Blind Study ◽

Double Blind ◽

Treatment Groups ◽

Inflammatory Agent ◽

Anti Inflammatory

A double-blind study was carried out to compare the effectiveness and tolerability of diftalone and phenylbutazone in thirty patients with classical or definite rheumatoid arthritis, randomly distributed between the two treatment groups. Both drugs were administered according to a progressively decreasing daily dosage schedule: 1,000 mg during the 1st week; 750 mg the 2nd week and 500 mg from the 3rd week on for diftalone; 400 mg, 300 mg, and 200 mg daily for the 1st, 2nd and from the 3rd week on respectively for phenylbutazone. The study lasted twelve weeks. The clinical controls and laboratory tests were performed weekly up to the 8th week, while the final evaluation was made at the end of the 3rd month. Twelve patients in the group receiving diftalone and fourteen in the phenylbutazone group completed the trial. Clinical improvement was observed in both groups. Effectiveness was somewhat more evident in the diftalone group. Tolerability was acceptable for both drugs, although the diftalone patients showed less frequent and intense side-effects than those treated with phyenylbutazone. No significant differences were found as regards the laboratory parameters, except a significant fall of the E.S.R. (p < 0·05) in the diftalone group. Diftalone seems to be an effective and safe anti-inflammatory agent in the treatment of rheumatoid arthritis.

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Long-term natural history of transient constrictive pericarditis

European Heart Journal ◽

10.1093/ehjci/ehaa946.2163 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J Ramchand ◽

J Chahine ◽

H Alnajjar ◽

M Chetrit ◽

P Cremer ◽

...

Keyword(s):

Natural History ◽

Constrictive Pericarditis ◽

Inflammatory Markers ◽

Diuretic Therapy ◽

Delayed Enhancement ◽

Duration Of Symptoms ◽

History Of ◽

Anti Inflammatory

Abstract Background In recent years, there has been increasing recognition of a potentially-reversible, transient/ subacute form of constrictive pericarditis (CP). To date, studies have been small with lack of long-term longitudinal follow-up. Purpose We aimed to elucidate the causes and natural history of subacute CP. Methods Patients were included if (1) they had a diagnosis of CP, (2) had cardiac magnetic resonance (CMR) within 12 months of symptom onset with evidence of pericardial delayed enhancement/ inflammation (Figure) (3) received anti-inflammatory medications. Results A total of 78 individuals were included, comprising 61 men (78%) with a mean age of 59±14 years. Causes of subacute CP included idiopathic/ viral pericarditis (58%), post-pericardiotomy (29%), autoimmune (6%), radiation therapy (3%) and others (4%). After median follow-up of 4.4 years, 31 (40%) required pericardiectomy. There were no deaths. Patients who underwent pericardiectomy had longer duration of symptoms at presentation [6 (4–9) vs. 3 (2–5) months, P<0.01], were more likely to be on diuretic therapy (87 vs. 45%, P<0.001), had lower ultra-sensitive C-reactive protein [4.4 (2.6–13.1) vs. 11.95 (1.8–61.55) mg/dl, P<0.001] and lower erythrocyte sedimentation rate [5 (2–10) vs. 25 (6–43 mm/hr), P=0.031] compared to those who were managed medically. There were no other significant differences in clinical characteristics or baseline anti-inflammatory therapy. The presence of elevated inflammatory markers (HR: 0.18; 95% CI: 0.06–0.58, P<0.01) was an independent predictor of freedom from pericardiectomy after adjustment for relevant clinical and imaging parameters. Conclusions We present the original observations of the largest cohort of patients with transient CP to date and demonstrate that increased inflammatory markers were independently associated with long-term freedom from pericardiectomy. Our results suggest that a trial of anti-inflammatory therapy in the setting of elevated inflammatory markers may be appropriate prior to referral for surgery given the possible reversibility. Pericardial delayed enhancement Funding Acknowledgement Type of funding source: None

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Lithium Toxicity in the Setting of Nonsteroidal Anti-Inflammatory Medications

Case Reports in Nephrology ◽

10.1155/2013/839796 ◽

2013 ◽

Vol 2013 ◽

pp. 1-2

Author(s):

Syed Hassan ◽

Fatima Khalid ◽

Zaid Alirhayim ◽

Syed Amer

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Clinical Improvement ◽

Neurological Deficit ◽

Multiple Organ ◽

Lithium Toxicity ◽

Lithium Clearance ◽

Organ Systems ◽

The Central Nervous System ◽

Anti Inflammatory

Lithium toxicity is known to affect multiple organ systems, including the central nervous system. Lithium levels have been used in the diagnosis of toxicity and in assessing response to management. There is evidence that nonsteroidal anti-inflammatory medications (NSAIDs) can increase lithium levels and decrease renal lithium clearance. We present a case of lithium toxicity, which demonstrates this effect and also highlights the fact that lithium levels do not correlate with clinical improvement, especially the neurological deficit.

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Anti-inflammatory effects of salmeterol compared with beclomethasone in eosinophilic mild exacerbations of asthma: A randomized, placebo controlled trial

Canadian Respiratory Journal ◽

10.1155/1998/868379 ◽

1998 ◽

Vol 5 (4) ◽

pp. 261-268 ◽

Cited By ~ 39

Author(s):

Mark O Turner ◽

Patrick R Johnston ◽

Emilio Pizzichini ◽

Marcia MM Pizzichini ◽

Pat A Hussack ◽

...

Keyword(s):

Clinical Improvement ◽

Geometric Mean ◽

Beta Agonist ◽

Airflow Limitation ◽

Clinical Test ◽

Clinical Parameters ◽

Sputum Eosinophils ◽

Anti Inflammatory ◽

Long Acting ◽

Blood Eosinophils

BACKGROUND: Salmeterol is a potent long acting beta-agonist that is effective in relieving the symptoms and airflow limitation of asthma.OBJECTIVE: To determine whether the effect of salmeterol on clinical parameters in a mild eosinophilic exacerbation of asthma was similar to that of beclomethasone dipropionate (BDP) and, thus, is due to an anti-inflammatory property.PATIENTS AND METHODS: Thirty-four asthmatics with a persistent increase in symptoms for at least two weeks and an increase of sputum eosinophils of 4% or more were randomized in a double-blind fashion to one of three groups that received daily treatment with 100 µg salmeterol, 1 mg BDP or placebo in divided doses using identical pressurized inhalers. Patients were treated with study medications for three weeks, followed by one week of open label BDP (500 µg bid). Patients were seen at weekly intervals, and sputum and blood were obtained on each visit. The primary outcome measure was a change in sputum eosinophils, and secondary outcomes were changes in blood eosinophils, eosinophilic cationic protein (ECP) and clinical parameters. Three patients (one in each group) could not produce any sputum after randomization and were excluded from the analysis.RESULTS: Twelve patients received salmeterol, 10 received BDP and nine received placebo. Salmeterol treatment had no effect on sputum eosinophils geometric mean, (from 35.5 [24.9] to 26.9% [25.8]), blood eosinophils (from 7.6 [4.8] to 7.2% [3.9]) or ECP (from 33.1 [18.1] to 27.8 [16.3] mg/L) but improved morning peak expiratory flow (PEF) and diurnal variation of PEF, and decreased the use of rescue medication more than placebo (P<0.05 for all comparisons). In contrast, BDP improved both inflammatory indexes (sputum eosinophils from 22.5 [17.9] to 5.7% [6.8], blood eosinophils from 9.0 [5.5] to 2.1% 1.0, and serum ECP from 36.5 [22.0] to 16.1 [10.1] mg/L) as well as clinical parameters.CONCLUSIONS: These results show that salmeterol improves the symptoms and airway function of patients with asthma, but has no effect on eosinophilic airway infiltration. These findings support current asthma guidelines, which recommend the initial use of inhaled steroid to maximize clinical improvement. While salmeterol also produces clinical improvement, it does not suppress sputum eosinophilia. The analysis of induced or spontaneous sputum for inflammatory indexes may be a valuable clinical test to guide the use of inhaled steroid and/or a long acting beta-agonist.

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