Improvement in left ventricular mechanics following medical treatment of constrictive pericarditis

Heart. 2021 May;107(10):828-835. doi: 10.1136/heartjnl-2020-317304. Epub 2021 Jan 6.

Abstract

Objective: 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.

Methods: 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 (LSlateral/LSseptal) by two-dimensional speckle-tracking echocardiography. Longitudinal data were analysed using a mixed effects model.

Results: 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 LSlateral/LSseptal and lateral/septal e'. During follow-up, only transient CP showed improvement in lateral/septal e' (p<0.001) and LSlateral/LSseptal (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 LSlateral/LSseptal were associated with clinical resolution of CP using anti-inflammatory therapy.

Conclusions: Improvement of constrictive physiology detected by lateral/septal e' and LSlateral/LSseptal was associated with resolution of clinical symptoms after anti-inflammatory treatment. Serial monitoring of these markers could be used to identify transient CP.

Keywords: echocardiography; pericardial constriction.

MeSH terms

  • Anti-Inflammatory Agents / therapeutic use
  • Blood Sedimentation
  • C-Reactive Protein / analysis
  • Colchicine / therapeutic use
  • Echocardiography, Doppler*
  • Female
  • Follow-Up Studies
  • Heart Septum / diagnostic imaging
  • Heart Ventricles / diagnostic imaging
  • Humans
  • Magnetic Resonance Imaging, Cine
  • Male
  • Middle Aged
  • Pericarditis, Constrictive / diagnostic imaging
  • Pericarditis, Constrictive / therapy*
  • Pericardium / surgery
  • Prednisone / therapeutic use
  • Retrospective Studies
  • Ventricular Function, Left*

Substances

  • Anti-Inflammatory Agents
  • C-Reactive Protein
  • Colchicine
  • Prednisone