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Original research
Clinical significance of pulmonary hypertension in patients with constrictive pericarditis
  1. Kyunghee Lim1,
  2. Jeong Hoon Yang2,3,
  3. William R Miranda4,
  4. Sung-A Chang2,
  5. Dong Seop Jeong5,
  6. Rick A Nishimura4,
  7. Hartzell Schaff6,
  8. Wern Miin Soo7,
  9. Kevin L Greason6,
  10. Jae K Oh2,4
  1. 1Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea (the Republic of)
  2. 2Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  3. 3Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the republoic of)
  4. 4Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  5. 5Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul, Korea (the Republic of)
  6. 6Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
  7. 7Department of Cardiology, National University Hospital, Singapore
  1. Correspondence to Dr William R Miranda, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, USA; miranda.william{at}mayo.edu

Abstract

Objectives We investigated haemodynamics and clinical outcomes according to type of pulmonary hypertension (PH) in patients with constrictive pericarditis (CP).

Background As the prevalence of CP with concomitant myocardial disease (mixed CP) grows, PH is more commonly seen in patients with CP. However, haemodynamic and outcome data according to the presence or absence of PH are limited.

Methods 150 patients with surgically confirmed CP who underwent echocardiography and cardiac catheterisation within 7 days at two tertiary centres were divided into three groups: no-PH, isolated postcapillary PH (Ipc-PH) and combined postcapillary and precapillary PH (Cpc-PH). Primary outcome was all-cause mortality during follow-up.

Result In this retrospective cohort study, 110 (73.3%) had PH (mean pulmonary artery pressure ≥25 mm Hg). Cpc-PH, using defined cut-offs for pulmonary vascular resistance (>3 Wood units) or diastolic pulmonary gradient (≥7 mm Hg), was seen in 18 patients (12%). The Cpc-PH group had a higher prevalence of comorbidities (diabetes and atrial fibrillation) and concomitant myocardial disease as an aetiology of CP than other groups. Pulmonary vascular resistance had a significant direct correlation with medial E/e′ by Doppler echocardiography (r=0.404, p<0.001). Survival rate was significantly lower in the Cpc-PH than the no-PH (p=0.002) and Ipc-PH (p=0.024) groups. On multivariable analysis, age, New York Heart Association functional class IV, medial e′ velocity, Cpc-PH and Ipc-PH were independently associated with long-term mortality.

Conclusion Combined postcapillary and precapillary PH develops in a subset of patients with CP and is associated with long-term mortality after pericardiectomy.

  • constrictive pericarditis
  • pulmonary hypertension

Data availability statement

No data are available. Due to privacy and ethical concerns, neither the data nor the source of the data can be made available.

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Data availability statement

No data are available. Due to privacy and ethical concerns, neither the data nor the source of the data can be made available.

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Footnotes

  • KL and JHY contributed equally.

  • Contributors JHY, WRM and JKO conceived the idea of the study. KL, JHY, WRM and JKO screened the studies and performed data extraction. All authors were involved in the acquisition, analysis or interpretation of data. KL and JHY drafted the manuscript, and JHY, WRM and JKO reviewed the manuscript for final submission. All authors have seen and approved the manuscript and have contributed significantly to the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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