Constrictive Pericarditis: A Commonly Missed Cause of Treatable Diastolic Heart Failure

Bhattad, Pradnya Brijmohan; Jain, Vinay

doi:10.7759/cureus.8024

Cited by 14 publications

(18 citation statements)

References 34 publications

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“…The causes of low cardiac output syndrome are related to the incomplete resection of thickened pericardium, unsatisfactory relief of left ventricular compression, excessive ventricular dilatation after pericardial dissection, myocardial weakness, and heart failure [ 8 ]. In our study, univariate and multivariate analyses showed that postoperative LVEDD ( P < 0.001) is associated with multiorgan failure (Table 5 ), indicating that the incomplete resection of thickened pericardium and unsatisfactory relief of left ventricular compression are associated with multiorgan failure following pericardiectomy.…”

Section: Discussionmentioning

confidence: 99%

Analysis of risk factors of multiorgan failure after pericardiectomy for constrictive pericarditis

Wen

Yang

et al. 2022

J Cardiothorac Surg

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Background We aimed to investigate risk factors of multiorgan failure following pericardiectomy. Methods This was a retrospective study of patients undergoing pericardiectomy between January 1994 and May 2021 at three hospitals. Results 826 patients were included in the study and divided into two groups: group with multiorgan failure (n = 86) and group without multiorgan failure (n = 740). There were 86 patients with multiorgan failure (86/826, 10.4%). There were 66 operative deaths (66/826, 8.0%). The causes of operative deaths were multiorgan failure, including cardiogenic shock + AKI + ventricular fibrillation (13/66), cardiogenic shock + AKI (35/66), cardiogenic shock + AKI + hepatic failure + septicemia (8/66), cardiogenic shock + AKI + respiratory failure (10/66). Univariate and multivariate analyses showed the factors associated with multiorgan failure, including male (P = 0.006), time between symptoms and surgery (P < 0.001), thickness of pericardium (P < 0.001), intubation time (P < 0.001), ICU retention time (P < 0.001), hospitalized time postoperative (P < 0.001), preoperative central venous pressure (P < 0.001), postoperative central venous pressure (P < 0.001), D0 fluid balance (P < 0.001), D2 fluid balance (P < 0.001), postoperative chest drainage (P < 0.001), preoperative LVEDD(P < 0.001), postoperative LVEDD (P < 0.001), surgical duration (P < 0.001), bleeding during operation (P < 0.001), serum creatinine 24 h after surgery (P = 0.042), serum creatinine 48 h after surgery (P < 0.001), fresh-frozen plasma (P < 0.001), packed red cells (P < 0.001), blood lactate (P < 0.001). Conclusion In our study, incomplete pericardial dissection, fluid overload, delayed diagnosis and treatment are associated with multiorgan failure following pericardiectomy.

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Section: Discussionmentioning

confidence: 99%

Analysis of risk factors of multiorgan failure after pericardiectomy for constrictive pericarditis

Wen

Yang

et al. 2022

J Cardiothorac Surg

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“…According to Kidney Disease Improving Global Outcomes classi cation, if serum creatinine increases by ≥ 0.3 mg/dl (26.5 μmol/l) within 48 hours, serum creatinine is 50% higher than the baseline within rst seven days, or urine output is below 0.5 ml/kg/hour for six hours, the patient is considered to have acute renal injury. [12,13] Multiorgan failure is regarded as a continuous process of varying levels of organ failure rather than an all-or-none event. To characterize multiorgan failure, six different organ systems are regarded as "key organs": lungs, cardiovascular system, kidneys, liver, coagulation system, and central nervous system.…”

Section: Preoperative Diuresis Protocolmentioning

confidence: 99%

“…The causes of low cardiac output syndrome are related to the incomplete resection of thickened pericardium, unsatisfactory relief of left ventricular compression, excessive ventricular dilatation after pericardial dissection, myocardial weakness, and heart failure. [11][12][13] In our study, postoperative LVEDD of group with multiorgan failure was signi cantly smaller (not larger) than that in group without multiorgan failure (40.2±0.4 mm versus 44.0±0.1 mm, P 0.001) and univariate and multivariate analyses showed that postoperative LVEDD (P 0.001) is associated with multiorgan failure (Table 7), indicating that the incomplete resection of thickened pericardium and unsatisfactory relief of left ventricular compression are associated with multiorgan failure following pericardiectomy.…”

Section: Incomplete Pericardial Dissection Is Associated With Multiorgan Failure Following Pericardiectomymentioning

confidence: 99%

Analysis of Risk Factors of Multiorgan Failure After Pericardiectomy For Constrictive Pericarditis

Wen¹,

Yang²,

Li³

et al. 2021

Preprint

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Background: We aimed to investigate risk factors of multiorgan failure following pericardiectomy.Methods: This was a retrospective study of patients undergoing pericardiectomy between January 1994 and May 2021 at three hospitals.Results: 826 patients were included in the study and divided into two groups: group with multiorgan failure (n=86) and group without multiorgan failure (n=740). There were 86 patients with multiorgan failure (86/826, 10.4%). There were 66 operative deaths (66/826, 8.0%). The causes of operative deaths were multiorgan failure (86/826, 10.4%), including cardiogenic shock + AKI + ventricular fibrillation (15/86), cardiogenic shock + AKI (46/86), cardiogenic shock + AKI + hepatic failure + septicemia (10/86), cardiogenic shock + AKI + respiratory failure (15/86). Univariate and multivariate analyses showed the factors associated with multiorgan failure, including male (P=0.006), time between symptoms and surgery (P＜0.001), thickness of pericardium (P＜0.001), intubation time (P＜0.001), ICU retention time (P＜0.001), hospitalized time postoperative (P＜0.001), preoperative central venous pressure (P＜0.001), postoperative central venous pressure (P＜0.001), D0 fluid balance (P＜0.001), D2 fluid balance (P＜0.001), postoperative chest drainage (P＜0.001), preoperative LVEDD(P＜0.001), postoperative LVEDD (P＜0.001), surgical duration (P＜0.001), bleeding during operation (P＜0.001), serum creatinine 24h after surgery (P=0.042), serum creatinine 48h after surgery (P＜0.001), fresh-frozen plasma (P＜0.001), packed red cells (P＜0.001), blood lactate (P＜0.001).Conclusion: In our study, incomplete pericardial dissection, fluid overload, delayed diagnosis and treatment are associated with multiorgan failure following pericardiectomy.

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“… 2 Furthermore, no test in isolation can provide definitive diagnostic evidence for constrictive pericarditis. 3 Here, we present a case of a patient presenting with acute liver failure, where the diagnosis and management of constrictive pericarditis was guided by multi-modality cardiovascular imaging.…”

Section: Introductionmentioning

confidence: 99%

The role of multi-modality cardiovascular imaging in a patient presenting with acute liver failure secondary to constrictive pericarditis: a case report

Demetriades

Oatham

Satchithananda

2022

European Heart Journal - Case Reports

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Background Constrictive pericarditis is a rare cause of heart failure which often presents a diagnostic challenge to clinicians. Case summary We describe the case of a 62-year-old male who presented to our institution with symptoms and signs suggestive of acute liver failure. Abdominal imaging demonstrated congestive hepatopathy. Clinical suspicion despite a ‘normal’ echocardiogram and sub-threshold NT-proBNP led to multi-modality cardiovascular imaging investigations to determine the cause of the heart failure syndrome. His cardiovascular magnetic resonance scan confirmed ventricular interdependence and extensive late enhancement in the pericardium with associated pericardial effusion. An 18F-fluorodeoxyglucose-positron emission tomography scan confirmed active pericardial inflammation. Cardiac computed tomography showed minimal pericardial calcification. Following confirming the diagnosis of effusive-constrictive pericarditis with evidence of active pericardial inflammation on imaging, a discussion within the Heart multidisciplinary team concluded that a trial of medical therapy with steroids is justifiable to avoid high-risk pericardiectomy. The patient was successfully treated with a combination of ibuprofen, colchicine, and prednisolone resulting in clinical improvement and remission of his symptoms. The imaging investigations were repeated 6 months later and confirmed radiological remission and medical therapy was discontinued. Discussion We stress the importance of multi-modality cardiovascular imaging in the diagnosis of constrictive pericarditis and also emphasize its role in identifying the subset of patients who may respond to medical therapy, therefore reducing the risk of high need surgical pericardiectomy.

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Constrictive Pericarditis: A Commonly Missed Cause of Treatable Diastolic Heart Failure

Abstract: Bhattad et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 14 publications

References 34 publications

Analysis of risk factors of multiorgan failure after pericardiectomy for constrictive pericarditis

Analysis of risk factors of multiorgan failure after pericardiectomy for constrictive pericarditis

Analysis of Risk Factors of Multiorgan Failure After Pericardiectomy For Constrictive Pericarditis

The role of multi-modality cardiovascular imaging in a patient presenting with acute liver failure secondary to constrictive pericarditis: a case report

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