Atrial natriuretic peptide and hemodynamic response to pericardiectomy for chronic constrictive pericarditis

Svanegaard, Jens; Thayssen, Per; Arendrup, Henrik K.

doi:10.1016/0002-9149(90)90750-u

Cited by 14 publications

(2 citation statements)

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“…A similar pattern of lower than expected atrial natriuretic peptide (ANP) values given the degree of elevation in left ventricular filling pressures has been described previously in patients with constrictive pericarditis [5, 6]. In the first reported case, the ANP level increased from 78.4 pg/ml preoperatively to 225 pg/ml following pericardiectomy despite a decrease in right atrial and pulmonary capillary wedge pressures from 29 to 15 mmHg [5].…”

Section: Discussionsupporting

confidence: 66%

B‐type natriuretic peptide level in a patient with constrictive pericarditis

Brown

Hollman

2006

Cathet Cardio Intervent

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Section: Discussionsupporting

confidence: 66%

B‐type natriuretic peptide level in a patient with constrictive pericarditis

Brown

Hollman

2006

Cathet Cardio Intervent

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“…According to a previous study, the total body fluid of constrictive pericarditis patients increased by 36% and primarily occurred in the extracellular space (81%) (Anand et al 1991 ). The underlying mechanism was considered to be constrictive diastolic filling dysfunction, which not only increases venous pressure but also induces systematic hormone disturbances, including impaired secretion of atrial natriuretic factor and stimulation of the renin-angiotensin-aldosterone system (Svanegaard et al 1990 ; Anand et al 1989 ). A high central venous pressure before pericardiectomy implies more severe fluid retention in both the intravascular and extravascular spaces.…”

Section: Discussionmentioning

confidence: 99%

Predictors of low cardiac output after isolated pericardiectomy: an observational study

et al. 2022

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Background Low cardiac output is the main cause of perioperative death after pericardiectomy for constrictive pericarditis. We investigated the associated risk factors and consequences. Methods We selected constrictive pericarditis patients undergoing isolated pericardiectomy from January 2013 to January 2021. Postoperative low cardiac output was defined as requiring mechanical circulatory support or more than one inotrope to maintain a cardiac index > 2.2 L •min−1 •m−2 without hypoperfusion, despite adequate filling status. Uni- and multivariable analysis were used to identify factors associated with low cardiac output. Cox regression was used to identify factors associated with length of hospital stay. Results Among 212 patients with complete data, 55 (25.9%) developed low cardiac output within postoperative day 1 (quartiles 1 and 2), which caused seven of the nine perioperative deaths. The rates of atrial arrhythmia, renal dysfunction, hypoalbuminemia, modest-to-severe hyponatremia, and hyperbilirubinemia caused by constrictive pericarditis were 9.4%, 12.3%, 49.1%, 10.4%, and 81.6%. The mean preoperative central venous pressure and cardiac index were 18 ± 5 cmH2O and 1.87 ± 0.45 L•min−1•m−2. Univariable analysis showed that low cardiac output patients had higher rates of atrial arrhythmia (OR 3.32 [1.35, 8.17], P = 0.007), renal dysfunction (OR 4.24 [1.94, 9.25], P < 0.001), hypoalbuminemia (OR 1.99 [1.06, 3.73], P = 0.031) and hyponatremia (OR 6.36 [2.50, 16.20], P < 0.001), greater E peak velocity variation (difference 2.8 [0.7, 5.0], P = 0.011), higher central venous pressure (difference 3 [2,5] cmH2O, P < 0.001) and lower cardiac index (difference − 0.27 [− 0.41, − 0.14] L•min−1•m−2, P < 0.001) than patients without low cardiac output. Multivariable regression showed that atrial arrhythmia (OR 4.04 [1.36, 12.02], P = 0.012), renal dysfunction (OR 2.64 [1.07, 6.50], P = 0.035), hyponatremia (OR 3.49 [1.19, 10.24], P = 0.023), high central venous pressure (OR 1.17 [1.08, 1.27], P < 0.001), and low cardiac index (OR 0.36 [0.14, 0.92], P = 0.032) were associated with low cardiac output (AUC 0.79 [0.72–0.86], P < 0.001). Cox regression analysis showed that hyperbilirubinemia (HR 0.66 [0.46, 0.94], P = 0.022), renal dysfunction (HR 0.51 [0.33, 0.77], P = 0.002), and low cardiac output (HR 0.42 [0.29, 0.59], P < 0.001) were associated with length of hospital stay. Conclusions Early recognition and management of hyponatremia, renal dysfunction, fluid retention, and hyperbilirubinemia may benefit constrictive pericarditis patients after pericardiectomy.

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Constrictive pericarditis: Its history and current status

Fowler

1995

Clinical Cardiology

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Summary:The diagnosis of constrictive pericarditis remains a challenge because it is often mimicked by restrictive cardiomyopathy. The last few years have seen numerous advances in our ability to differentiate between these two conditions which often have similar physical findings and hemodynamics. This review begins with a brief history of constrictive pericarditis; this is followed by an extensive discussion of newer etiologies, and then the classical clinical history and physical examination findings are described. Radiologic, electrocardiographic, and angiographic findings are discussed. The hernodynamics of constrictive pericarditis are reviewed. Recent results of echocadiographic and echo-Doppler investigations are presented. Emphasis is placed upon the limitations of M-mode echocardiography in the diagnosis of constrictive pericarditis. The value of echocardiographic Doppler studies of mitral and tricuspid flow velocity patterns, as well as of those in the pulmonary veins and hepatic veins, is described. Nuclear ventriculograms and angiocardiograms tend to show more rapid ventricular filling in constrictive pericarditis than in restrictive cardiomyopathy. Although only a small number of patients has been studied, these evaluations seem to have merit in separating restrictive cardiomyopathy from constrictive pericarditis. The role of computed tomography scanning and magnetic resonance imaging studies of pericardial thickness in confirming the presence of constrictive pericarditis is discussed. Abnormal pericardial thickening (> 3 mm) confirms the diagnosis of constrictive pericarditis, but only if the characteristic hernodynamic pattern is present. The usefulness of endomyocardial biopsy in recognizing specific varieties of re- strictive cardiomyopathy is presented. The topic of occult constrictive pericardial disease is discussed briefly. A discussion of the timing of pericardial resection for the treatment of constrictive pericarditis ends the review.

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Atrial natriuretic peptide and hemodynamic response to pericardiectomy for chronic constrictive pericarditis

Cited by 14 publications

References 5 publications

B‐type natriuretic peptide level in a patient with constrictive pericarditis

B‐type natriuretic peptide level in a patient with constrictive pericarditis

Predictors of low cardiac output after isolated pericardiectomy: an observational study

Constrictive pericarditis: Its history and current status

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