Department of cardiac surgery, People's Hospital of Liaoning Province, Shenyang, China.
Department of Cardiovascular Function, People's Hospital of China Medical University, People's Hospital of Liaoning Province, Shenyang, China.
Curr Probl Cardiol. 2022 Dec;47(12):101356. doi: 10.1016/j.cpcardiol.2022.101356. Epub 2022 Aug 22.
Diffuse primary malignant pericardial mesothelioma (PMPM) is an extremely rare and highly invasive tumor of pericardium. The tumor can infiltrate myocardium in part of cases, and will contribute to grave prognosis. Herein, we reported a 58-year-old man of diffuse PMPM with myocardial involvement, and summarized 39 cases of diffuse PMPM. Multimodal echocardiography, which combined conventional, tissue Doppler and speckle tracking echocardiography, was applied to diagnose diffuse PMPM with myocardial involvement, and assess the myocardial function. The common features were pericardial effusion, pericardial masses and thickened pericardium. The other echocardiographic characteristics were extensive and heterogenous echo, adhesion with pericardium and myocardium, reduced motion of adhered myocardium, and constriction performance. Diffuse PMPM with myocardial involvement revealed decreased LV diastolic function, and decreased LV and RV systolic function. Especially in systolic function, the unique strain features were reduced longitudinal strains from segmental to global and from epicardial to endocardial, relative 'septal sparing' pattern, and decreased transmural gradient of longitudinal strain. Our findings suggested that multimodal echocardiography not only can identify this disease, but also can provide detailed information of myocardial dysfunction, which provides a reference for clinicians to develop an optimal individualized treatment.
弥漫性原发性恶性心包间皮瘤（PMPM）是一种极其罕见且高度侵袭性的心包肿瘤。部分病例肿瘤可浸润心肌，导致预后不良。本文报道了 1 例 58 岁弥漫性 PMPM 合并心肌受累患者，并对 39 例弥漫性 PMPM 患者进行了总结。多模态超声心动图（常规、组织多普勒和斑点追踪超声心动图）用于诊断合并心肌受累的弥漫性 PMPM，并评估心肌功能。常见特征包括心包积液、心包肿块和心包增厚。其他超声心动图特征包括广泛、不均匀回声、与心包和心肌粘连、粘连心肌运动受限和收缩功能受限。弥漫性 PMPM 合并心肌受累患者左心室舒张功能降低，左心室和右心室收缩功能降低。在收缩功能方面，节段性到全局性、心外膜到心内膜的纵向应变降低，存在独特的应变特征，相对“间隔保留”模式，以及纵向应变的跨壁梯度降低。我们的研究结果表明，多模态超声心动图不仅可以识别这种疾病，还可以提供心肌功能障碍的详细信息，为临床医生制定最佳个体化治疗方案提供参考。
