RT Journal Article
SR Electronic
T1 Improvement in left ventricular mechanics following medical treatment of constrictive pericarditis
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 828
OP 835
DO 10.1136/heartjnl-2020-317304
VO 107
IS 10
A1 Kimi Sato
A1 Ayman Ayache
A1 Arnav Kumar
A1 Paul C Cremer
A1 Brian Griffin
A1 Zoran B Popovic
A1 Christine Jellis
A1 Deborah H Kwon
A1 Michael Bolen
A1 Jay Ramchand
A1 Michael Chetrit
A1 Muhammad M Furqan
A1 Douglas Johnston
A1 Allan L Klein
YR 2021
UL http://heart.bmj.com/content/107/10/828.abstract
AB 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’ (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.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.Data are available upon reasonable request to the corresponding author.