Fernandes Fábio, Melo Dirceu Thiago Pessoa de, Ramires Felix José Alvarez, Dias Ricardo Ribeiro, Tonini Marcio, Fernandes Vinicius Dos Santos, Rochitte Carlos Eduardo, Moreira Carlos Henrique Valente, Mady Charles
Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil.
Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, SP - Brazil.
Arq Bras Cardiol. 2017 Nov;109(5):457-465. doi: 10.5935/abc.20170147. Epub 2017 Oct 2.
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.
To assess the clinical characteristics, sensitivity of imaging tests and factors related to the death of patients with constrictive pericarditis undergoing pericardiectomy.
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.
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.
Magnetic resonance imaging had better diagnostic sensitivity. Clinical, laboratory and imaging markers were associated with death.
国际研究报告了临床特征和实验室检查结果在缩窄性心包炎诊断中的价值。然而，巴西人群的数据却很稀少。
评估接受心包切除术的缩窄性心包炎患者的临床特征、影像学检查的敏感性以及与死亡相关的因素。
对手术确诊的缩窄性心包炎患者的临床和实验室变量进行回顾性评估。使用了两种方法：经胸超声心动图和心脏磁共振成像。通过Cox比例风险模型和风险比进行单因素分析来确定死亡预测因素。所有检验均为双侧检验，α错误≤5%被认为具有统计学意义。
我们研究了84例患者（平均年龄44±17.9岁；67%为男性）。主要表现为右心衰竭的体征和症状，分别有89%、89%和62%的病例出现颈静脉怒张、水肿和腹水。特发性病因占69.1%，其次是结核病（21%）。尽管心力衰竭程度较重，但脑钠肽（BNP）水平较低（中位数为157 pg/mL）。超声心动图和磁共振成像对缩窄的诊断敏感性分别为53.6%和95.9%。有9例死亡（1
