Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea (the Republic of).
Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of).
Heart. 2021 Oct;107(20):1651-1656. doi: 10.1136/heartjnl-2021-319149. Epub 2021 Jul 20.
We investigated haemodynamics and clinical outcomes according to type of pulmonary hypertension (PH) in patients with constrictive pericarditis (CP).
As the prevalence of CP with concomitant myocardial disease (mixed CP) grows, PH is more commonly seen in patients with CP. However, haemodynamic and outcome data according to the presence or absence of PH are limited.
150 patients with surgically confirmed CP who underwent echocardiography and cardiac catheterisation within 7 days at two tertiary centres were divided into three groups: no-PH, isolated postcapillary PH (Ipc-PH) and combined postcapillary and precapillary PH (Cpc-PH). Primary outcome was all-cause mortality during follow-up.
In this retrospective cohort study, 110 (73.3%) had PH (mean pulmonary artery pressure ≥25 mm Hg). Cpc-PH, using defined cut-offs for pulmonary vascular resistance (>3 Wood units) or diastolic pulmonary gradient (≥7 mm Hg), was seen in 18 patients (12%). The Cpc-PH group had a higher prevalence of comorbidities (diabetes and atrial fibrillation) and concomitant myocardial disease as an aetiology of CP than other groups. Pulmonary vascular resistance had a significant direct correlation with medial E/e' by Doppler echocardiography (=0.404, p<0.001). Survival rate was significantly lower in the Cpc-PH than the no-PH (p=0.002) and Ipc-PH (p=0.024) groups. On multivariable analysis, age, New York Heart Association functional class IV, medial e' velocity, Cpc-PH and Ipc-PH were independently associated with long-term mortality.
Combined postcapillary and precapillary PH develops in a subset of patients with CP and is associated with long-term mortality after pericardiectomy.
本研究旨在探讨缩窄性心包炎（CP）患者不同类型肺动脉高压（PH）的血流动力学特征和临床结局。
随着合并心肌疾病（混合 CP）的 CP 患病率增加，CP 患者中 PH 更为常见。然而，关于 PH 存在或不存在时的血流动力学和预后数据有限。
在两个三级中心，对 150 例经手术证实的 CP 患者进行超声心动图和心导管检查，检查时间在 7 天内。将患者分为三组：无 PH 组、孤立性毛细血管后 PH（Ipc-PH）组和毛细血管后和小动脉前 PH 混合存在（Cpc-PH）组。主要终点为随访期间的全因死亡率。
在这项回顾性队列研究中，110 例（73.3%）患者存在 PH（平均肺动脉压≥25mmHg）。根据肺血管阻力（>3 伍德单位）或舒张期肺梯度（≥7mmHg）的定义界值，18 例（12%）患者存在 Cpc-PH。与其他组相比，Cpc-PH 组更常见合并症（糖尿病和心房颤动）和 CP 的心肌疾病病因。肺血管阻力与多普勒超声心动图测量的中层 E/e'值呈显著直接相关（r=0.404，p<0.001）。Cpc-PH 组的生存率明显低于无 PH 组（p=0.002）和 Ipc-PH 组（p=0.024）。多变量分析显示，年龄、纽约心脏协会心功能分级 IV 级、中层 e'速度、Cpc-PH 和 Ipc-PH 是长期死亡率的独立相关因素。
在 CP 患者中，毛细血管后和小动脉前 PH 是一个亚组患者的特征，与心包切除术的长期死亡率相关。
