Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Heart. 2021 May;107(10):828-835. doi: 10.1136/heartjnl-2020-317304. Epub 2021 Jan 6.
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.
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 (LS/LS) by two-dimensional speckle-tracking echocardiography. Longitudinal data were analysed using a mixed effects model.
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 LS/LS and lateral/septal e'. During follow-up, only transient CP showed improvement in lateral/septal e' (p<0.001) and LS/LS (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 LS/LS were associated with clinical resolution of CP using anti-inflammatory therapy.
Improvement of constrictive physiology detected by lateral/septal e' and LS/LS was associated with resolution of clinical symptoms after anti-inflammatory treatment. Serial monitoring of these markers could be used to identify transient CP.
患有活动性炎症的缩窄性心包炎（CP）患者可能通过抗炎治疗得到缓解。我们旨在通过超声心动图研究 CP 患者使用抗炎药物对缩窄性病理生理学的影响。
我们确定了 35 名接受 CP 诊断后接受抗炎药物（秋水仙碱、泼尼松、非甾体抗炎药）治疗的 CP 患者（平均年龄 58±13；80%为男性）。CP 的临床缓解（一过性 CP）定义为随访期间纽约心脏协会心功能分级的改善。我们通过组织多普勒成像测量侧壁和间隔二尖瓣环的组织速度峰值早期舒张（e'）比值（侧壁/间隔 e'）或二维斑点追踪超声心动图测量左心室侧壁和间隔壁纵向应变（LS/LS）比值来评估缩窄性病理生理学。使用混合效应模型分析纵向数据。
中位随访 323 天期间，20 例患者出现一过性 CP，15 例患者出现持续性 CP。与持续性 CP 相比，一过性 CP 的基线红细胞沉降率（ESR）更高（p=0.003）。LS/LS 和侧壁/间隔 e'无显著差异。随访期间，仅一过性 CP 显示侧壁/间隔 e'（p<0.001）和 LS/LS 改善（p=0.003），两组炎症标志物的恢复相似。在逻辑模型中，更高的基线 ESR 以及侧壁/间隔 e'和 LS/LS 的更大改善与 CP 经抗炎治疗后的临床缓解相关。
通过侧壁/间隔 e'和 LS/LS 检测到的缩窄性生理学的改善与抗炎治疗后临床症状的缓解相关。这些标志物的连续监测可用于识别一过性 CP。
