Pericardial Effusions in Pulmonary Arterial Hypertension

Fenstad, Eric R.; Le, Rachel J.; Sinak, Lawrence J.; Kremers, Hilal Maradit; Ammash, Naser M.; Ayalew, Assefa M.; Villarraga, Hector R.; Oh, Jae K.; Frantz, Robert P.; McCully, Robert B.; McGoon, Michael D.; Kane, Garvan C.

doi:10.1378/chest.12-3033

Cited by 82 publications

(18 citation statements)

References 26 publications

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“…a) Regurgitation valvular disease: moderate to severe regurgitation of the mitral and/or the aortic valve was defined based on the European Association of Echocardiography recommendations for the assessment of valvular regurgitation [24] – [25] ; b) Pericardial effusion: the severity of pericardial effusion was characterized as trace to small if the pericardial space was separated by <1 cm in the diastole in any plane. Moderate or severe effusion was defined as a pericardial space separation of >1 cm during the diastole as described previously [26] – [27] ; and c) Left ventricular systolic and diastolic dysfunction was defined based on European Society of Cardiology (ESC) Guidelines for the diagnosis of acute and chronic heart failure 2012 and recommendations by the American Society of Echocardiography as well as the European Association of Echocardiography [28] – [29] .…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Hypertension: Epidemiology in Different CKD Stages and Its Association with Cardiovascular Morbidity

Liang

Liu

et al. 2014

PLoS ONE

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BackgroundPulmonary hypertension (PH) was recently recognized as a common complication of end-stage renal disease (ESRD) that causes an increased risk of mortality. Epidemiological data for this disorder in earlier stages of chronic kidney disease (CKD) and its association with cardiovascular (CV) morbidity are scarce.MethodsWe retrospectively analyzed 2,351 Chinese CKD patients with complete clinical records and echocardiography data between Jan 2008 and May 2012. The patients were divided into the following 6 groups: CKD Stages 1–4; Stage 5 for those not on or initiated on hemodialysis for <3 months; and Stage 5D for the patients undergoing hemodialysis for ≥3 months. The prevalence of PH and CV morbidity was investigated, and their association was evaluated with a logistic regression model.ResultsPH was detected in 426 patients (18.1%). Mild, moderate and severe PH was diagnosed in 12.1%, 4.9% and 1.1% of the patients, respectively. Severe PH was detected in CKD Stages 5 and 5D. CV morbidity was found in 645 patients (27.4%). Compared with the non-PH group, the PH group had a higher risk for cardiac disease but not for cerebrovascular disease risk. PH severity was associated with cardiac morbidity risk [odds ratio (95% CI) for mild PH: 1.79 (1.30–2.47); moderate PH: 2.75 (1.73–4.37); severe PH: 3.90 (1.46–10.42)].ConclusionsOur study showed for the first time the epidemiology profile of PH across the spectrum of CKD. Mild-to-moderate PH occurs with more frequency in advanced CKD, and severe PH is scarce in non-ESRD CKD. PH in CKD is associated with cardiac but not cerebrovascular disease, with increasing cardiac morbidity seen with increasing PH severity. Evidence from prospective studies addressing PH in this population is needed to predict cardiac events.

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Section: Introductionmentioning

confidence: 99%

Pulmonary Hypertension: Epidemiology in Different CKD Stages and Its Association with Cardiovascular Morbidity

Liang

Liu

et al. 2014

PLoS ONE

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“…These processes result in increased filtration and lymphatic obstruction, resulting in pericardial effusion. 220 …”

Section: Specific Aetiologies Of Pericardial Syndromesmentioning

confidence: 99%

2015 ESC Guidelines for the diagnosis and management of pericardial diseases

Adler¹,

Charron²,

Imazio³

et al. 2015

European Heart Journal

1,812

705

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“…(28,32-38) In the current study, increased liver stiffness was associated with septal bounce on MRI, larger inferior vena cava, Doppler echo evidence of hepatic vein diastolic expiratory flow reversal ratio ≥ 0.79, and respirophasic variation of the mitral inflow velocity > 25% which are findings that may be seen in constriction among other cardiovascular disease and reflect the hemodynamic changes that occur with constriction. (24,26) Increased liver stiffness is a surrogate of either congestive hepatopathy or hepatic fibrosis from chronic congestion which is challenging to distinguish between without tissue for histologic analysis. Liver stiffness was associated with increased pericardial thickening, septal bounce on MRI, abnormal septal motion on echocardiography, hepatic vein diastolic expiratory reversal ratio ≥ 0.79, and respirophasic mitral inflow velocity variation which are considered surrogate indicators of constriction.…”

Section: Discussionmentioning

confidence: 99%

“…Imaging windows included parasternal long and short axis, apical, and subcostal positions. Right atrial pressure (RAP) estimation was based on inferior vena cava size and distensibility as previously described (24). Right ventricular systolic pressure was estimated based on the modified Bernoulli equation (4v 2 + estimated RAP, where v = tricuspid regurgitant velocity) per American Society of Echocardiography guidelines (25).…”

Section: Methodsmentioning

confidence: 99%

Evaluation of liver stiffness with magnetic resonance elastography in patients with constrictive pericarditis: Preliminary findings

Fenstad

Dzyubak

et al. 2015

Magnetic Resonance Imaging

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Background Constrictive pericarditis (CP) results in reduced pericardial compliance, ventricular interdependence, and right heart failure. Patients with untreated CP may develop liver fibrosis and ultimately cirrhosis due to chronic venous congestion. Chronic venous congestion ± fibrosis may lead to increased liver stiffness. Magnetic Resonance Elastography (MRE) was used to evaluate whether patients with CP have increased hepatic stiffness. Methods Prospectively, patients with suspected CP underwent 2D transthoracic echocardiography, cardiac MRI, and liver MRE. An automated method was used to draw regions of interest (ROI) on the stiffness maps to calculate the mean liver stiffness in kilopascals (kPa). A t-test with α = 0.05 was performed between stiffness values of patients with positive and negative CP findings based on previously published echocardiography criteria. Results Nineteen patients met inclusion criteria with a mean ± SD age of 51 ± 16years. Nine patients (47%) had CP. Mean liver stiffness trended higher in patients with CP compared to those without CP (4.04 kPa vs. 2.46; p=0.045). Liver stiffness correlated with MRI septal bounce (p=0.04), inferior vena cava size (p=0.003), echo abnormal septal motion (p=0.04), and echo mitral inflow variation >25% (p=0.02). Only MRI septal bounce predicted CP by echocardiography (p<0.001). Conclusion CP was associated with increased liver stiffness. The increased stiffness is most likely secondary to chronic hepatic venous congestion and/or fibrosis. MRE may be useful for noninvasive liver stiffness assessment in CP.

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Pericardial Effusions in Pulmonary Arterial Hypertension

Cited by 82 publications

References 26 publications

Pulmonary Hypertension: Epidemiology in Different CKD Stages and Its Association with Cardiovascular Morbidity

Pulmonary Hypertension: Epidemiology in Different CKD Stages and Its Association with Cardiovascular Morbidity

2015 ESC Guidelines for the diagnosis and management of pericardial diseases

Evaluation of liver stiffness with magnetic resonance elastography in patients with constrictive pericarditis: Preliminary findings

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