Como eu faço avaliação ecocardiográfica de pericardite constritiva / My approach to echocardiographic assessment for constrictive pericarditis

A pericardite constritiva (PC) é uma condição na qual a cicatrização e perda de elasticidade do pericárdio resultam em enchimento ventricular prejudicado, disfunção diastólica e insuficiência cardíaca direita. O diagnóstico dessa patologia é desafiador, sendo frequente a necessidade de técnicas de imagem multimodal, dentre as quais a ecocardiografia representa a modalidade de imagem inicial para a avaliação diagnóstica, além de permitir a diferenciação da PC da cardiomiopatia restritiva (CMR) e outras condições que mimetizam constrição. (AU)

Constrictive pericarditis (CP) is a condition in which scarring and loss of elasticity of the pericardium result in impaired ventricular filling, diastolic dysfunction, and right heart failure. The diagnosis of this pathology is challenging, with frequent need for multimodal imaging techniques, among which echocardiography represents the initial imaging modality for the diagnostic evaluation, in addition to allowing the differentiation of CP from restrictive cardiomyopathy (RCM) and other conditions that mimic constriction. (AU)

Constrictive Pericarditis and Cardiac Tamponade Due to Tuberculosis as Presentation of Human Immunodeficiency Virus/Syndrome of Acquired Immunodeficiency: Case Report / Pericarditis constrictiva y taponamiento cardíaco por tuberculosis como presentación de virus de inmunodeficiencia humana/síndrome de inmunodeficiencia adquirida: presentación de caso / Pericardite constritiva e tamponamento cardíaco devido à tuberculose com uma apre-sentação do vírus da imunodeficiência adquirida: relato de cas

We report a case of constrictive pericarditis due to extrapulmonary tuberculosis associated with Human Immuno-deficiency Virus, complicated by cardiac tamponade that required surgical intervention in a drug user patient. The importance of early diagnosis and management is widely highlighted

El artículo presenta un caso de pericarditis constrictiva secundaria a tuberculosis extrapulmonar en un paciente con prueba positiva para virus de inmunodeficiencia humana (VIH) consumidor de sustancias psicoactivas, quien durante la hospitalización desarrolló un taponamiento cardíaco con requerimiento de intervención quirúrgica. Se plantea la discusión de la importancia de cada una de las pruebas solicitadas y el manejo adecuado en pacientes con dichas patologías

O artigo apresenta um caso de pericardite constritiva secundária à tuberculose extrapulmonar em paciente com teste positiva para vírus da imunodeficiência humana (HIV) e usuário de substâncias psicoativas que, durante a internação, desenvolveu tamponamento cardíaco com necessidade de intervenção cirúrgica. Discute-se a importância de cada um dos exames solicitados e o manejo ade-quado de pacientes com essas patologias

Histopatología y Strain auricular en pericarditis constrictiva y miocardiopatía restrictiva / Histopathology and Atrial Strain in Constrictive Pericarditis and restrictive cardiomyopathy

Resumen La pericarditis constrictiva y la miocardiopatía restrictiva son enfermedades raras caracterizadas por síntomas de insuficiencia cardíaca congestiva. El objetivo de este estudio es mostrar el diagnóstico diferencial de estas dos patologías, mediante strain auricular y establecer su correlación con la histopatología de corazones correspondientes. Se analizan 2 casos clínicos representativos de cada una de estas patologías. Se analizan sus presentaciones clínicas, los datos ecocardiograficos y en ambos casos se realizaron biopsias endomiocardicas con lo cual se presenta la correlación histológica. El strain auricular permitió evaluar la afección de las aurículas, consideramos que el strain auricular disminuido podría estar relacionado con la presencia de fibrosis.

Abstract Histopathology and Atrial Strain in Constrictive Pericarditis and restrictive cardiomyopathy Constrictive pericarditis and restrictive cardiomyopathy are rare diseases characterized by congestive heart failure symptoms. The aim of this study is to show the differential diagnosis of these two pathologies using strain and to establish their correlation with histopathology of the corresponding hearts. Two representative clinical cases of each of these pathologies are analyzed. Their clinical presentations, echocardiographic data, and endomyocardial biopsies were performed in both cases, thus presenting the histological correlation. Atrial strain allowed us to evaluate the affection of the atria, we consider that decreased atrial strain could be related to the presence of fibrosis.

Constrictive pericarditis with extensive calcification and caseous necrosis

Abstract Constrictive pericarditis is a disease where loss of pericardial elasticity and restriction of filling of the cardiac chambers occurs. It is most often seen as an associated symptom of heart failure. Pericardiectomy provides effective treatment for patients with symptomatic constrictive pericarditis, although high rates of morbidity and mortality are related to the procedure. We present a case with extensive calcification, massive caseous necrosis and an important impairment of right ventricular function successfully operated in our institution.

Value of left ventricular myocardial strain derived from cardiac magnetic resonance tissue tracking on differentiating constrictive pericarditis from restrictive cardiomyopathy / 中华心血管病杂志

Objective: To compare left ventricular myocardial mechanics detected by cardiac magnetic resonance tissue tracking(CMR-TT) between patients with constrictive pericarditis(CP) and restrictive cardiomyopathy(RCM),and see if those can be used to differentiate CP from RCM patients. Methods: A total of 23 patients with CP, 20 patients with RCM, who hospitalized in Beijing Anzhen Hospital from January 2014 to April 2019 were included in this study and 25 healthy subjects served as control group, all subjects underwent cardiac magnetic resonance examination. Myocardial mechanics were evaluated by 2-dimensional(2D) and 3-dimensional(3D) CMR-TT in terms of global longitudinal strain(GLS), circumferential strain(GCS), radial strain(GRS) and the lateral wall strain to septal wall strain ratio(lateral/septal ratio) of basal, mid-cavity and apical. The diagnostic area under the receiver operating characteristic curve (ROC) was evaluated for differentiating CP from RCM. Results: Age, sex and heart rate were similar between CP and RCM patients(all P>0.05). 2D-GLS, 3D-GLS, GCS and GRS in CP and RCM groups were significantly lower than those in normal control group(all P<0.05).3D-GLS value was significantly lower in RCM patients than in CP patients(P<0.05), the area under the curve (AUC)=0.787(sensitivity 80%, specificity 78%). 3D-GCS was significantly lower in CP group than in RCM group(P<0.05), the AUC=0.737(sensitivity 80%, specificity 65%). However, there was no significant difference between CP and RCM in 3D-GRS(P>0.05). Compared with RCM, the circumferential and radial lateral/septal ratios of the basal were significantly lower in CP group than in RCM group(both P<0.05), AUC=0.737(sensitivity 70%, specificity 83%) and 0.737 (sensitivity 60%, specificity 87%), respectively. The left ventricular myocardial mechanics strain curve of the CP,RCM and normal control were different. The CP patients presented as " rapidly down-a platform" form, the RCM presented as "slowly down" form, and normal control presented as "rapidly down" form. Conclusion: Evaluating the differences in the diastolic process of left ventricular myocardium and left ventricular myocardial mechanics strain curve is helpful to differentiate CP from RCM patients.

Pericarditis Constrictiva, variedad fibroelástica. Nuevas técnicas diagnósticas por imágenes / Constrictive Fibrous Pericarditis. Novel Diagnostic Imaging Techniques

Abstract Constrictive Pericarditis is a disease characterized by fibrous thickening of the pericardium that generates a failure in cardiac function. The case of a 54-year-old man, marathon runner with progressive symptoms of congestive heart failure and significantly reduction of Functional Class II-III (NYHA) lasting seven months is presented. Clinical findings are described and the diagnostic value of several imaging techniques - echocardiography, multi-slice computerized tomography and cardiac magnetic resonance - is emphasized. Constrictive fibrous pericarditis was confirmed at pericardiectomy.

Hepatomegalia como forma de presentación en pericarditis constrictiva: Caso clínico pediátrico / Hepatomegaly as a form of presentation in constrictive pericarditis: A pediatric clinical case

La pericarditis constrictiva es una entidad poco frecuente en pediatría, en la cual existe una limitación para la diástole cardíaca por fibrosis del pericardio. El origen etiopatogénico de esta patología es múltiple, encontrándose en primer lugar, la pericarditis constrictiva idiopática y, en segundo, la infección por Mycobacterium tuberculosis. El diagnóstico constituye un desafío clínico, ya que requiere de un alto grado de sospecha. Suele presentarse de forma oligosintomática. La presencia de edema, ascitis y alteración de la función hepática suele orientar el estudio hacia una enfermedad hepática primaria. Una cuidadosa historia clínica y examen físico, junto con estudios por imágenes adecuados, constituyen las piedras angulares del diagnóstico. El tratamiento quirúrgico realizado de forma oportuna resulta curativo en la gran mayoría de los pacientes. Se presenta el caso de un paciente de 16 años que inicia estudios por hallazgo de hepatomegalia asociada a disnea grado 1-2 en un control de salud habitual.

Constrictive pericarditis is a rare entity in pediatrics in which there is a limitation for cardiac diastole due to fibrosis of the pericardium. The etiopathogenic origin of this pathology is multiple, finding idiopathic constrictive pericarditis firstly and Mycobacterium tuberculosis infection secondly. Diagnosis is a clinical challenge since it requires a high degree of suspicion. It usually presents as oligosymptomatic or with signs and symptoms of low cardiac output. The presence of edema, ascites and impaired liver function usually guides the study towards primary liver disease. A careful clinical history and physical examination together with adequate imaging studies are the cornerstones of the diagnosis. Surgical treatment is curative in the vast majority of patients. We present the case of a 16-year-old patient with hepatomegaly and dyspnea grade 1-2 found in a routine health check-up.

Pericarditis constrictiva asociada a calcificación pericárdica extensa / Constrictive pericarditis associated with extensive pericardial calcification

Resumen Se expone el caso de una paciente femenina de 39 años, con antecedente de disnea progresiva y eventos recurrentes de palpitaciones, en quien durante examen físico se observó ingurgitación yugular, ascitis de gran importancia y tercer ruido cardíaco compatible con "golpe pericárdico". Las pruebas de laboratorio mostraron niveles aumentados de péptido cerebral natriurético y titulación positiva de anticuerpos para el factor antinuclear. La radiografía de tórax mostró imagen radiopaca alrededor de la silueta cardiaca en patrón de "cáscara de huevo". La reconstrucción tomográfica evidenció calcificación pericárdica circunferencial difusa, incluida la pared miocárdica del ventrículo izquierdo y el músculo anteromedial papilar de la válvula mitral.

Abstract It is presented the case of a 39 year-old female patient with a history of progressive dyspnoea and recurrent palpitation events. On physical examination jugular ingurgitation was observed, as well as a highly significant ascites, and heart sounds compatible with "pericardial knock". The laboratory test results reported increased levels of brain natriuretic peptide and a positive antibody titre for antinuclear factor. The chest X-ray showed a radio-opaque image around the cardiac outline in an "egg shell pattern". The computed tomography reconstruction showed evidence of a diffuse calcification of the pericardial circumference, including the myocardial wall of the left ventricle and the antero-medial papillary muscle of the mitral valve.

Calcificación heterotópica miocárdica y pericarditis constrictiva en contexto de sepsis por a propósito de un caso / Case Report: Myocardial heterotopic calcification and constrictive pericarditis in the context of sepsis due to

We report the case of a 21 years old woman without history of cardiovascular disease, who after her first euthocic delivery, did complain of genital infection of white parts complicated by pneumonia and pyothorax, isolating Streptococcus pyogenes, requiring intensive care, inotropic and vasoactive medication. Transesophageal echocardiography showed constrictive pericarditis and myocardial heterotopic calcification in the context of sepsis. Subsequently, the pericardial constriction and clinical symptoms improved, with persistent calcifications. The echocardiogram prior to delivery was completely normal.

Presentamos el caso de una mujer de 21 años sin antecedentes cardiovasculares quien posterior a primer parto eutócico simple presenta infección genital de partes blancas complicada con neumonía y piotórax, aislándose Streptococcus pyogenes, ameritando cuidados intensivos, inotrópicos y vasoactivos. El ecocardiograma transesofágico evidenció pericarditis constrictiva y calcificación heterotópica miocárdica en contexto de sepsis. Posteriormente mejoró el cuadro de constricción pericárdica y la clínica, persistiendo las calcificaciones. El ecocardiograma previo al parto se encontraba completamente normal.

Pericardite constritiva por tuberculose, uma condição de difícil diagnóstico / Constrictive pericarditis due to tuberculosis a difficult diagnosis condition

A pericardite constritiva (PC) é uma condição clínica caracterizada pela presença de inflamação do tecido pericárdico, culminando em constrição cardíaca. A tuberculose pode acometer o pericárdio e levar à uma condição clínica conhecida como pericardite tuberculosa (PT). Relata-se o caso de um paciente jovem, internado com queixas de insuficiência cardíaca e quadro de PC em que o diagnóstico etiológico de PT foi confirmado por exclusão e resposta à terapêutica.

Pericarditis constrictiva por tuberculosis, una condición de difícil diagnóstico / Constrictive pericarditis due to tuberculosis, a difficult diagnosis condition

La pericarditis constrictiva (PC) es una condición clínica caracterizada por la presencia de inflamación del tejido pericárdico, culminando en constricción cardíaca. La tuberculosis puede afectar al pericardio y llevarlo a una condición clínica conocida como pericarditis tuberculosa (PT). Se relata el caso de un paciente joven, internado con síntomas de insuficiencia cardíaca y cuadro.

Importance of Clinical and Laboratory Findings in the Diagnosis and Surgical Prognosis of Patients with Constrictive Pericarditis / Importância dos Achados Clínicos e Laboratoriais no Diagnóstico e Prognóstico Cirúrgico de Pacientes com Pericardite Constritiva

Abstract Background: International studies have reported the value of the clinical profile and laboratory findings in the diagnosis of constrictive pericarditis. However, Brazilian population data are scarce. Objective: To assess the clinical characteristics, sensitivity of imaging tests and factors related to the death of patients with constrictive pericarditis undergoing pericardiectomy. Methods: Patients with constrictive pericarditis surgically confirmed were retrospectively assessed regarding their clinical and laboratory variables. Two methods were used: transthoracic echocardiography and cardiac magnetic resonance imaging. Mortality predictors were determined by use of univariate analysis with Cox proportional hazards model and hazard ratio. All tests were two-tailed, and an alpha error ≤ 5% was considered statically significant. Results: We studied 84 patients (mean age, 44 ± 17.9 years; 67% male). Signs and symptoms of predominantly right heart failure were present with jugular venous distention, edema and ascites in 89%, 89% and 62% of the cases, respectively. Idiopathic etiology was present in 69.1%, followed by tuberculosis (21%). Despite the advanced heart failure degree, low BNP levels (median, 157 pg/mL) were found. The diagnostic sensitivities for constriction of echocardiography and magnetic resonance imaging were 53.6% and 95.9%, respectively. There were 9 deaths (10.7%), and the risk factors were: anemia, BNP and C reactive protein levels, pulmonary hypertension >55 mm Hg, and atrial fibrillation. Conclusions: Magnetic resonance imaging had better diagnostic sensitivity. Clinical, laboratory and imaging markers were associated with death.

Resumo Fundamento: Estudos internacionais têm relatado o valor de perfil clínico e exames de imagem no diagnóstico e prognóstico da pericardite constritiva. Entretanto, dados da população brasileira são escassos. Objetivo: Avaliar as características clínicas, sensibilidade de exames de imagem e fatores relacionados ao óbito em uma série de casos de pericardite constritiva submetidos à pericardiectomia. Métodos: Pacientes com pericardite constritiva confirmada por cirurgia foram avaliados retrospectivamente quanto a variáveis clínicas e laboratoriais. Dois métodos diagnósticos foram utilizados: ecocardiograma transtorácico e ressonância cardíaca. Preditores de mortalidade foram determinados por análise univariada usando metodologia das proporções de Cox e hazard ratio. Todos os testes foram considerados bicaudais e um erro alfa ≤ 5% foi considerado como significante. Resultados: Foram estudados 84 pacientes com idade média de 44 ± 17,9 anos, sendo 67% do sexo masculino. Sinais e sintomas de insuficiência cardíaca (IC) predominantemente direita estiveram presentes com estase jugular, edema e ascite em 89%, 89% e 62% dos casos, respectivamente. Etiologia idiopática foi observada em 69% dos casos, seguida por tuberculose em 21%. Apesar do grau de IC, encontramos baixos níveis de BNP (mediana de 157 pg/mL). As sensibilidades diagnósticas para constrição do ecocardiograma e da ressonância foram 53,6% e 95,9%, respectivamente. Durante a evolução clínica, houve 9 óbitos (10,7%) e os fatores de risco foram: anemia, elevações de BNP, PCR, hipertensão pulmonar > 55 mmHg e fibrilação atrial. Conclusões: Pericardite constritiva manifesta-se com sinais e sintomas de IC biventricular com predomínio à direita e baixos níveis de BNP. A ressonância magnética apresenta melhor sensibilidade para diagnóstico. Marcadores clínicos, laboratoriais e de imagem estiveram associados ao óbito.

Pericarditis constrictiva: Causa de falla cardiaca en una paciente joven / Constrictive pericarditis: A cause of heart failure in a young patient

La pericarditis constrictiva es una causa de falla cardiaca derecha, que produce típicamente una alteración diastólica progresiva. Su corrección quirúrgica es posible con la pericardiectomía. La presentación en jóvenes y el compromiso importante de la función sistólica son escenarios infrecuentes. Se presenta el caso de una joven de 17 años con un cuadro de falla cardiaca congestiva. Los hallazgos de la ecocardiografía y resonancia cardiaca confirmaron el diagnóstico de pericarditis constrictiva. Se evidenció una disfunción sistólica con hipocinesia apical severa y con presencia de una masa a este nivel, compatible con trombo por la respuesta a anticoagulantes. La pericardiectomía se difirió por un alto riesgo operatorio y criterios de mal pronóstico por resonancia cardiaca. (AU)

Constrictive pericarditis is a cause of right heart failure that typically produces a progressive diastolic dysfunction. Pericardiectomy is the surgical indicated procedure. Presentation in young patients and systolic involvement are infrequent findings. We present the case of a 17-year-old female patient with congestive heart failure; findings of the heart ultrasound and magnetic resonance confirmed the diagnosis of constrictive pericarditis. Systolic dysfunction with severe apical hypokinesis and a mass like lesion compatible with a thrombus were observed. Pericardiectomy was deferred for the high surgical risk and for the bad prognostic findings on the magnetic resonance. (AU)