Prevalence and prognosis of pericardial effusion in patients affected by pectus excavatum: A case-control study

Conte, Edoardo; Agalbato, Cecilia; Lauri, Gianfranco; Mushtaq, Saima; Carollo, Chiara; Bonomi, Alice; Lorenza, Zanotto; Melotti, Eleonora; Dalla, Alessia; Guglielmo, Marco; Baggiano, Andrea; Annoni, Andrea; Formenti, Alberto; Mancini, Elisabetta; D'Angelo, Antonio Maria; Rota, Alessandra; Assanelli, Emilio; Sforza, Chiarella; Pepi, Mauro; Andreini, Daniele; Brucato, Antonio

doi:10.1016/j.ijcard.2021.10.005

Cited by 11 publications

(3 citation statements)

References 20 publications

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“…Usually, these pericardial effusions are not hemodynamically relevant and do not require surgical intervention. This was also shown in a recent CT study with a mean follow-up of 6.5 years 50 .…”

Section: Discussionsupporting

confidence: 75%

Description of a new clinical syndrome: thoracic constriction without evidence of the typical funnel-shaped depression—the "invisible" pectus excavatum

Hohneck

Ansari

Natale

et al. 2023

Sci Rep

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Pectus excavatum (PE) is a congenital malformation with a funnel-shaped depression of the sternum that can lead to cardiac symptoms. However, there are patients with thoracic constriction (defined as elevated Haller-Index > 3.25 determined by cardiac magnetic resonance imaging (CMR)) without visible evidence of PE, leading to similar complaints. Between January 2004 till June 2020, patients who underwent CMR for further evaluation of the heart, due to cardiac symptoms were enrolled and compared to controls. Biventricular global strain analysis was assessed using feature tracking (CMR-FT). ECG and/or Holter recordings were performed to detect rhythm events. Cardiac symptoms were evaluated in detail using a questionnaire. Finally, 88 patients (male 35, female 53) with elevated Haller-Index (3.9 ± 0.8) were included and compared to CMR data from 25 individuals with confirmed PE and 25 healthy controls (HC). Mean age at time of CMR was 35 ± 16 years. The most common symptoms at presentation were palpitations (41%), followed by dyspnea (24%) and atypical chest pain (14%). Three patients (3%) had atrial fibrillation or atrial flutter. Concomitant phenomena were pericardial effusion in 39% and mitral valve prolapse (MVP) in 27% of the study cohort. While there were no differences in left ventricular function or volumes, right ventricular function (RVEF) was significantly lower in patients with internal PE compared to HC (RVEF (%) 50 ± 5 vs 59 ± 4, p < 0.01). Strain analysis revealed only discrete changes in RV strain, implying a purely mechanical problem in the absence of structural changes. RV dimensions were negatively correlated with the size of thoracic indices (r = 0.41), reflecting the extent of thoracic constriction. MVP was more prevalent in patients with greater thoracic indices (r = 0.24). The described cohort, referred to as internal PE because of the absence of external changes, showed similar CMR morphologic findings as patients with real PE (especially altered dimensions of the right heart and a lower RVEF). In addition, there was a high incidence of rhythm disturbances, such as extrasystoles or arrhythmias. In one-third of the study cohort additional abnormalities such as pericardial effusion or MVP were present, with MVP being found more frequently in patients with larger thoracic indices, suggesting a possible common pathogenesis.Trial registration: ISRCTN registry, ISRCTN15355937, retrospectively registered 03.06.2022, https://www.isrctn.com/ISRCTN15355937?q=15355937&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10.

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Section: Discussionsupporting

confidence: 75%

Description of a new clinical syndrome: thoracic constriction without evidence of the typical funnel-shaped depression—the "invisible" pectus excavatum

Hohneck

Ansari

Natale

et al. 2023

Sci Rep

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“…An echocardiographic evaluation every 3–6 months is recommended for the follow-up of these patients, while invasive techniques such as pericardiocentesis or pericardiotomy, if separated from specific symptoms, are not recommended ( 246 ). Furthermore, we recently showed that a chronic pericardial effusion is present in 37% of subjects with pectus excavatum, with the size of effusion being related to the anatomical severity of the condition, and these effusions have a good prognosis ( 247 ). Thus, in presence of chronic pericardial effusion not related to pericarditis, often with normal or near-normal serum CRP, we do not recommend any therapy, in particular, we avoid immunosuppressive therapies since there is no evidence of benefit.…”

Section: New Insights On Pericarditismentioning

confidence: 99%

Immunomodulating Therapies in Acute Myocarditis and Recurrent/Acute Pericarditis

et al. 2022

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The field of inflammatory disease of the heart or “cardio-immunology” is rapidly evolving due to the wider use of non-invasive diagnostic tools able to detect and monitor myocardial inflammation. In acute myocarditis, recent data on the use of immunomodulating therapies have been reported both in the setting of systemic autoimmune disorders and in the setting of isolated forms, especially in patients with specific histology (e.g., eosinophilic myocarditis) or with an arrhythmicburden. A role for immunosuppressive therapies has been also shown in severe cases of coronavirus disease 2019 (COVID-19), a condition that can be associated with cardiac injury and acute myocarditis. Furthermore, ongoing clinical trials are assessing the role of high dosage methylprednisolone in the context of acute myocarditis complicated by heart failure or fulminant presentation or the role of anakinra to treat patients with acute myocarditis excluding patients with hemodynamically unstable conditions. In addition, the explosion of immune-mediated therapies in oncology has introduced new pathophysiological entities, such as immune-checkpoint inhibitor-associated myocarditis and new basic research models to understand the interaction between the cardiac and immune systems. Here we provide a broad overview of evolving areas in cardio-immunology. We summarize the use of new imaging tools in combination with endomyocardial biopsy and laboratory parameters such as high sensitivity troponin to monitor the response to immunomodulating therapies based on recent evidence and clinical experience. Concerning pericarditis, the normal composition of pericardial fluid has been recently elucidated, allowing to assess the actual presence of inflammation; indeed, normal pericardial fluid is rich in nucleated cells, protein, albumin, LDH, at levels consistent with inflammatory exudates in other biological fluids. Importantly, recent findings showed how innate immunity plays a pivotal role in the pathogenesis of recurrent pericarditis with raised C-reactive protein, with inflammasome and IL-1 overproduction as drivers for systemic inflammatory response. In the era of tailored medicine, anti-IL-1 agents such as anakinra and rilonacept have been demonstrated highly effective in patients with recurrent pericarditis associated with an inflammatory phenotype.

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“… 9 As the course and prognosis of PE depend on the underlying cause, the relevance of PE in idiopathic PE or chronic asymptomatic PE is particularly difficult to assess. 28 No calculators or scoring systems are available assisting in the prediction of the time course or outcome of PE. Current guidelines recommend monitoring of PE on the basis of its echocardiographic extent and clinical presentation.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Utility of Pericardial Effusion in the General Population: Findings From the STAAB Cohort Study

Sahiti,

Cejka,

Schmidbauer

et al. 2024

JAHA

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Background The incidental finding of a pericardial effusion (PE) poses a challenge in clinical care. PE is associated with malignant conditions or severe cardiac disease but may also be observed in healthy individuals. This study explored the prevalence, determinants, course, and prognostic relevance of PE in a population‐based cohort. Methods and Results The STAAB (Characteristics and Course of Heart Failure Stages A/B and Determinants of Progression) cohort study recruited a representative sample of the population of Würzburg, aged 30 to 79 years. Participants underwent quality‐controlled transthoracic echocardiography including the dedicated evaluation of the pericardial space. Of 4965 individuals included at baseline (mean age, 55±12 years; 52% women), 134 (2.7%) exhibited an incidentally diagnosed PE (median diameter, 2.7 mm; quartiles, 2.0–4.1 mm). In multivariable logistic regression, lower body mass index and higher NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) levels were associated with PE at baseline, whereas inflammation, malignancy, and rheumatoid disease were not. Among the 3901 participants attending the follow‐up examination after a median time of 34 (30–41) months, PE was found in 60 individuals (1.5%; n=18 new PE, n=42 persistent PE). Within the follow‐up period, 37 participants died and 93 participants reported a newly diagnosed malignancy. The presence of PE did not predict all‐cause death or the development of new malignancy. Conclusions Incidental PE was detected in about 3% of individuals, with the vast majority measuring <10 mm and completely resolving. PE was not associated with inflammation markers, death, incident heart failure, or malignancy. Our findings corroborate the view of current guidelines that a small PE in asymptomatic individuals can be considered an innocent phenomenon and does not require extensive short‐term monitoring.

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Prevalence and prognosis of pericardial effusion in patients affected by pectus excavatum: A case-control study

Cited by 11 publications

References 20 publications

Description of a new clinical syndrome: thoracic constriction without evidence of the typical funnel-shaped depression—the "invisible" pectus excavatum

Description of a new clinical syndrome: thoracic constriction without evidence of the typical funnel-shaped depression—the "invisible" pectus excavatum

Immunomodulating Therapies in Acute Myocarditis and Recurrent/Acute Pericarditis

Prognostic Utility of Pericardial Effusion in the General Population: Findings From the STAAB Cohort Study

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