-
Current Cardiology Reports Jan 2020This review provides an update on the immunopathogenesis of tuberculous pericarditis (TBP), investigations to confirm tuberculous etiology, the limitations of... (Review)
Review
PURPOSE OF REVIEW
This review provides an update on the immunopathogenesis of tuberculous pericarditis (TBP), investigations to confirm tuberculous etiology, the limitations of anti-tuberculous therapy (ATT), and recent efficacy trials.
RECENT FINDINGS
A profibrotic immune response characterizes TBP, with low levels of AcSDKP, high levels of γ-interferon and IL-10 in the pericardium, and high levels of TGF-β and IL-10 in the blood. These findings may have implications for future therapeutic targets. Despite advances in nucleic acid amplification approaches, these tests remain disappointing for TBP. Trials of corticosteroids and colchicine have had mixed results, with no impact on mortality, evidence of a reduction in rates of constrictive pericarditis and potential harm in those with advanced HIV. Small studies suggest that ATT penetrates the pericardium poorly. Given that there is a close association between high bacillary burden and mortality, a rethink about the optimal drug doses and duration may be required. The high mortality and morbidity from TBP despite use of anti-tuberculous drugs call for researches targeting host-directed immunological determinants of treatment outcome. There is also a need for the identification of steps in clinical management where interventions are needed to improve outcomes.
Topics: Antitubercular Agents; Disease Management; Humans; Pericardial Effusion; Pericarditis, Constrictive; Pericarditis, Tuberculous; Pericardium
PubMed: 31940097
DOI: 10.1007/s11886-020-1254-1 -
Clinical Cardiology Oct 2017A rising prevalence of end-stage renal disease (ESRD) has led to a rise in ESRD-related pericardial syndromes, calling for a better understanding of its pathophysiology,... (Review)
Review
A rising prevalence of end-stage renal disease (ESRD) has led to a rise in ESRD-related pericardial syndromes, calling for a better understanding of its pathophysiology, diagnoses, and management. Uremic pericarditis, the most common manifestation of uremic pericardial disease, is a contemporary problem that calls for intensive hemodialysis, anti-inflammatories, and often, drainage of large inflammatory pericardial effusions. Likewise, asymptomatic pericardial effusions can become large and impact the hemodynamics of patients on chronic hemodialysis. Constrictive pericarditis is also well documented in this population, ultimately resulting in pericardiectomy for definitive treatment. The management of pericardial diseases in ESRD patients involves internists, cardiologists, and nephrologists. Current guidelines lack clarity with respect to the management of pericardial processes in the ESRD population. Our review aims to describe the etiology, classification, clinical manifestations, diagnostic imaging tools, and treatment options of pericardial diseases in this population.
Topics: Heart; Hemodynamics; Humans; Incidence; Kidney; Kidney Failure, Chronic; Pericardial Effusion; Pericarditis, Constrictive; Prevalence; Risk Factors; Treatment Outcome; Uremia
PubMed: 28873222
DOI: 10.1002/clc.22770 -
Journal of the American College of... Nov 2016Differentiation of constrictive pericarditis (CP) from restrictive cardiomyopathy (RCM) is a complex and often challenging process. Because CP is a potentially curable... (Review)
Review
Differentiation of constrictive pericarditis (CP) from restrictive cardiomyopathy (RCM) is a complex and often challenging process. Because CP is a potentially curable cause of heart failure and therapeutic options for RCM are limited, distinction of these 2 conditions is critical. Although different in regard to etiology, prognosis, and treatment, CP and RCM share a common clinical presentation of predominantly right-sided heart failure, in the absence of significant left ventricular systolic dysfunction or valve disease, due to impaired ventricular diastolic filling. Fundamental to the diagnosis of either condition is a clear understanding of the underlying hemodynamic principles and pathophysiology. We present a contemporary review of the pathophysiology, hemodynamics, diagnostic assessment, and therapeutic approach to patients presenting with CP and RCM.
Topics: Cardiomyopathy, Restrictive; Diagnosis, Differential; Hemodynamics; Humans; Pericarditis, Constrictive
PubMed: 27884252
DOI: 10.1016/j.jacc.2016.08.050 -
Circulation Journal : Official Journal... Oct 2008Constrictive pericarditis (CP) is characterized by scarring and loss of elasticity of the pericardium, resulting in external impedance of cardiac filling. In the...
Constrictive pericarditis (CP) is characterized by scarring and loss of elasticity of the pericardium, resulting in external impedance of cardiac filling. In the developed world, CP is most frequently encountered as a consequence of previous cardiac surgery, thoracic irradiation, viral or idiopathic causes. Tuberculosis still remains a common cause of CP in the developing world, immigrants from underdeveloped nations, and immunosuppressed patients. Clinical signs and symptoms of right heart failure coupled with risk factors for pericardial disease should raise suspicion for CP. Echocardiographic evaluation and often cardiac catheterization are essential components of accurate diagnosis of CP. Enhanced interventricular dependence, with respiratory variation in the ventricular pressures, and ventricular discordance are the pathophysiologic hallmarks of CP. Imaging findings such as increased pericardial thickness or pericardial calcification on computed tomography can be supportive, but are not necessary for the diagnosis of CP. Pericardiectomy remains the most effective therapy for symptomatic CP.
Topics: Cardiac Catheterization; Echocardiography; Hemodynamics; Magnetic Resonance Imaging; Pericarditis, Constrictive; Ultrasonography, Doppler, Pulsed
PubMed: 18762706
DOI: 10.1253/circj.cj-08-0654 -
Texas Heart Institute Journal Apr 2017Constrictive pericarditis is the final stage of a chronic inflammatory process characterized by fibrous thickening and calcification of the pericardium that impairs... (Review)
Review
Constrictive pericarditis is the final stage of a chronic inflammatory process characterized by fibrous thickening and calcification of the pericardium that impairs diastolic filling, reduces cardiac output, and ultimately leads to heart failure. Transthoracic echocardiography, computed tomography, and cardiac magnetic resonance imaging each can reveal severe diastolic dysfunction and increased pericardial thickness. Cardiac catheterization can help to confirm a diagnosis of diastolic dysfunction secondary to pericardial constriction, and to exclude restrictive cardiomyopathy. Early pericardiectomy with complete decortication (if technically feasible) provides good symptomatic relief and is the treatment of choice for constrictive pericarditis, before severe constriction and myocardial atrophy occur. We describe our surgical approach to constrictive pericarditis, summarize our results in 93 patients, and provide a brief overview of the literature.
Topics: Cardiac Catheterization; Humans; Pericardiectomy; Pericarditis, Constrictive; Predictive Value of Tests; Recovery of Function; Treatment Outcome; Ventricular Function
PubMed: 28461794
DOI: 10.14503/THIJ-16-5772 -
The New England Journal of Medicine Jan 2004Effusive-constrictive pericarditis is an uncommon pericardial syndrome characterized by concomitant tamponade, caused by tense pericardial effusion, and constriction,...
BACKGROUND
Effusive-constrictive pericarditis is an uncommon pericardial syndrome characterized by concomitant tamponade, caused by tense pericardial effusion, and constriction, caused by the visceral pericardium. We conducted a prospective study of its clinical evolution and management.
METHODS
From 1986 through 2001, all patients with effusive-constrictive pericarditis were prospectively evaluated. Combined pericardiocentesis and cardiac catheterization were performed in all patients, and pericardiectomy was performed in those with persistent constriction. Follow-up ranged from 1 month to 15 years (median, 7 years).
RESULTS
A total of 1184 patients with pericarditis were evaluated, 218 of whom had tamponade. Of these 218, 190 underwent combined pericardiocentesis and catheterization. Fifteen of these patients had effusive-constrictive pericarditis and were included in the study. All patients presented with clinical tamponade; however, concomitant constriction was recognized in only seven patients. At catheterization, all patients had elevated intrapericardial pressure (median, 12 mm Hg; interquartile range, 7 to 18) and elevated right atrial and end-diastolic right and left ventricular pressures. After pericardiocentesis, the intrapericardial pressure decreased (median value, -5 mm Hg; interquartile range, -5 to 0), whereas right atrial and end-diastolic right and left ventricular pressures, although slightly reduced, remained elevated, with a dip-plateau morphology. The causes were diverse, and death was mainly related to the underlying disease. Pericardiectomy was required in seven patients, all of whom had involvement of the visceral pericardium. Three patients had spontaneous resolution.
CONCLUSIONS
Effusive-constrictive pericarditis is an uncommon pericardial syndrome that may be missed in some patients who present with tamponade. Although evolution to persistent constriction is frequent, idiopathic cases may resolve spontaneously. In our opinion, extensive epicardiectomy is the procedure of choice in patients requiring surgery.
Topics: Adolescent; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Cardiac Tamponade; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pericardial Effusion; Pericardiectomy; Pericardiocentesis; Pericarditis, Constrictive; Prospective Studies; Treatment Outcome
PubMed: 14749455
DOI: 10.1056/NEJMoa035630 -
Current Cardiology Reports Oct 2022The unique pathophysiological changes of constrictive pericarditis (CP) can now be identified with better imaging modalities, thereby helping in its early diagnosis.... (Review)
Review
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. 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.
Topics: Humans; Multimodal Imaging; Pericarditis, Constrictive
PubMed: 35917048
DOI: 10.1007/s11886-022-01758-6 -
The Journal of the American Osteopathic... Jun 2018
Topics: Female; Humans; Middle Aged; Pericarditis, Constrictive; Radiography, Thoracic; Tomography, X-Ray Computed
PubMed: 29809259
DOI: 10.7556/jaoa.2018.089 -
The Pan African Medical Journal 2021To the best of our knowledge there are no publications about Tunisian experience in constrictive pericarditis (CP); the aim of this study was therefore to review our... (Review)
Review
To the best of our knowledge there are no publications about Tunisian experience in constrictive pericarditis (CP); the aim of this study was therefore to review our twenty-one years' experience in terms of clinical and surgical outcomes and risk factors of death after pericardiectomy. An analytic bicentric and retrospective study carried out on 25 patients (20 male) with CP underwent pericardiectomy, collected over a 21-years period. The mean age was 40.46±16.74 years [7.5-72]. The commonest comorbid factor was tabagism (52%). The most common etiology was tuberculosis (n = 11, 44%). Dyspnea was the most common functional symptom (n = 21, 84%). Pericardiectomy was performed in all our patients within 2.9±3.19 months after confirmation of diagnosis. It was subtotal in 96% of cases. The commonest postoperative complications are pleural effusion (20%). Dyspnea was regressed within 1.8 months in 80% of cases and clinical signs of right heart failure within a mean duration of 1.62 months in 53% of cases. Perioperative mortality was 12% (3 deaths), late mortality was 4% (1 patient). Cardiopulmonary bypass, New York Heart Association (NYHA) over class II and right ventricular dysfunction are the prognostic factors of mortality (p = 0.001, 0.046, 0.019). Tuberculosis as etiology of CP had no impact on mortality. CP is a rare disease, with non-specific clinical signs. Pericardiectomy is effective with a significant improvement of the functional status of patients and favorable outcome at short and long term nevertheless hospital mortality is not negligible and depends on many factors.
Topics: Adolescent; Adult; Aged; Cardiopulmonary Bypass; Child; Female; Hospital Mortality; Humans; Male; Middle Aged; Pericardiectomy; Pericarditis, Constrictive; Postoperative Complications; Retrospective Studies; Risk Factors; Tunisia; Young Adult
PubMed: 33912311
DOI: 10.11604/pamj.2021.38.141.22884 -
Brazilian Journal of Cardiovascular... May 2023The mainstay of the treatment of constrictive pericarditis is pericardiectomy. However, surgery is associated with high early morbidity and mortality and low long-term...
INTRODUCTION
The mainstay of the treatment of constrictive pericarditis is pericardiectomy. However, surgery is associated with high early morbidity and mortality and low long-term survival. The aim of this study is to describe our series of pericardiectomies performed over 30 years.
METHODS
A descriptive, observational, and retrospective analysis of all pericardiectomies performed at the Institute of Cardiology and Cardiovascular Surgery of the Favaloro Foundation was performed.
RESULTS
A total of 45 patients underwent pericardiectomy between June 1992 and June 2022, mean age was 52 years (standard deviation ± 13.9 years), and 73.3% were men. Idiopathic constrictive pericarditis was the most prevalent (46.6%). The variables significantly associated with prolonged hospitalization were preoperative advanced functional class (incidence of 38.4%, P<0.04), persistent pleural effusion (incidence of 81.8%, P<0.01), and although there was no statistical significance with the use of cardiopulmonary bypass, a trend in this association is evident (P<0.07). We found that 100% of the patients with an onset of symptoms greater than six months had a prolonged hospital stay. In-hospital mortality was 6.6%, and 30-day mortality was 8.8%. The preserved functional class is 17 times more likely to improve their symptomatology after pericardiectomy (odds ratio 17, 95% confidence interval 2.66-71; P<0.05).
CONCLUSION
Advanced functional class at the time of pericardiectomy is the variable most strongly associated with mortality and prolonged hospitalization. Onset of the symptoms greater than six months is also a poor prognostic factor mainly associated with prolonged hospitalization; based on these data, we strongly support the recommendation of early intervention.
Topics: Male; Humans; Middle Aged; Female; Pericarditis, Constrictive; Retrospective Studies; Pericardiectomy; Morbidity; Time Factors; Treatment Outcome
PubMed: 36692052
DOI: 10.21470/1678-9741-2022-0302