Cardiac Decompression by Pericardiectomy for Constrictive Pericarditis: Multimodality Imaging to Identify Patients at Risk for Prolonged Inotropic Support

Alessia Azzu; Marco Morosin; Alexios S. Antonopoulos; Massimo Capoccia; Ulrich Rosendahl; Raad Mohiaddin

doi:https://doi.org/10.4250/jcvi.2020.0223

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저자정보: Alessia Azzu (Royal Brompton Hospital) Marco Morosin (Royal Brompton Hospital) Alexios S. Antonopoulos (Royal Brompton Hospital) Massimo Capoccia (Royal Brompton Hospital) Ulrich Rosendahl (Royal Brompton Hospital) Raad Mohiaddin (Royal Brompton Hospital)

저널정보: 한국심초음파학회 Journal of Cardiovascular Imaging Journal of Cardiovascular Imaging 제29권 제4호

발행연도: 2021.10

수록면: 361 - 372 (12page)

DOI: https://doi.org/10.4250/jcvi.2020.0223

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BACKGROUND: Post-pericardiectomy right ventricular (RV) failure has been reported but it remains not well-studied. To investigate imaging parameters that could predict RV function and the outcome of patients post-pericardiectomy. METHODS: We analysed data from a total of 53 CP patients undergoing pericardiectomy. Preoperative, early and at 6 months postoperative echocardiographic (echo) imaging datasets were analysed and correlated with preoperative cardiac magnetic resonance (CMR), cardiac computed tomography scans and histology. The primary endpoint of the study was RV functional status early postoperatively and at 6 months. Secondary endpoint was the need for prolonged inotropic support. RESULTS: A cause of CP was identified in 26 patients (49%). Inotropic support ≥ 48 hours was required in n = 28 (53%) of patients and was correlated with lower preoperative RV areas by echo or RV volumes by CMR (p < 0.05 for all). A pericardial score based on pericardial thickness/calcification and epicardial fat thickness had good diagnostic accuracy to identify patients requiring prolonged use of inotropes (area under the curve, 0.825; 95% confidence interval, 0.674?0.976). Pericardiectomy resulted in RV decompression and impaired RV function early postoperatively (fractional area change: 40.5% ± 8.8% preoperatively vs. 31.4% ± 10.4% early postoperatively vs. 42.5% ± 10.2% at 6 months, p < 0.001). CONCLUSIONS: We show that a smaller RV cavity size and a pericardial scoring system are associated with prolonged inotropic support in CP patients undergoing pericardiectomy. RV systolic impairment post decompression is present in most patients, but it is only transient.

#Pericardiectomy #Constrictive pericarditis #Magnetic resonance #Multislice computed tomography #Echocardiography

참고문헌 (21)

참고문헌 신청

Nishimura RA / 2001 / Constrictive pericarditis in the modern era : a diagnostic dilemma / Heart 86:619~623

Frank H / 1999 / Magnetic resonance imaging evaluation of myocardial and pericardial disease / J Magn Reson Imaging 10:617~626

Young PM / 2012 / MR imaging findings in 76 consecutive surgically proven cases of pericardial disease with CT and pathologic correlation / Int J Cardiovasc Imaging 28:1099~1109

Ling LH / 1999 / Constrictive pericarditis in the modern era : evolving clinical spectrum and impact on outcome after pericardiectomy / Circulation 100:1380~1386

Beckmann E / 2017 / Right-sided heart failure and extracorporeal life support in patients undergoing pericardiectomy for constrictive pericarditis : a risk factor analysis for adverse outcome / Thorac Cardiovasc Surg 65:662~670

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