Cardiac Magnetic Resonance Imaging Pericardial Late Gadolinium Enhancement and Elevated Inflammatory Markers Can Predict the Reversibility of Constrictive Pericarditis After Antiinflammatory Medical Therapy A Pilot Study
Cardiac Magnetic Resonance Imaging Pericardial Late Gadolinium Enhancement and Elevated Inflammatory Markers Can Predict the Reversibility of Constrictive Pericarditis After Antiinflammatory Medical Therapy A Pilot Study
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DOI：
10.1161/circulationaha.111.026070
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发表时间：
2011-10-25
期刊：
影响因子：
37.8
通讯作者：
Oh, Jae K.
中科院分区：
文献类型：
--
作者：
Feng, DaLi;Glockner, James;Oh, Jae K.
背景-缩窄性心包炎（CP）是一种致残性疾病，通常需要心包切除术来缓解心力衰竭。可逆CP已被描述，但没有已知的方法来预测可逆性。心包炎症可能是可逆性的标志。作为一项试点研究，我们评估了心脏磁共振成像心包晚钆增强（LGE）和炎症生物标志物是否可以预测可逆性CP后，cardiac therapy.Method和Results-Twenty-nine CP患者接受cardiac药物治疗后，心脏磁共振成像。随访13个月后，14例患者CP消退，而15例患者持续CP。可逆性CP组的基线LGE心包厚度大于持续性CP组（4 +/- 1 vs 2 +/- 1 mm，P=0.001）。93%的可逆性CP组和33%的持续性CP组的心包LGE定性强度为中度或重度（P=0.002）。心脏磁共振成像LGE心包厚度>= 3 mm预测CP可逆性的敏感性为86%，特异性为80%。可逆性CP组的基线C反应蛋白和红细胞沉降率也高于持续性CP组（分别为59 +/- 52 vs 12 +/- 14 mg/L，P=0.04和49 +/- 25 vs 15 +/- 16 mm/h，P=0.04）。抗炎治疗与C-反应蛋白，红细胞沉降率，心包LGE在可逆性CP组，但不是在持久性CP group. Conclusions可逆CP与心包和全身炎症的减少。抗炎治疗与心包和全身炎症和LGE心包厚度的减少以及CP生理学和症状的消退相关。需要在更多患者中进行进一步研究。（循环。2011;124：1830-1837.）
Background-Constrictive pericarditis (CP) is a disabling disease, and usually requires pericardiectomy to relieve heart failure. Reversible CP has been described, but there is no known method to predict the reversibility. Pericardial inflammation may be a marker for reversibility. As a pilot study, we assessed whether cardiac magnetic resonance imaging pericardial late gadolinium enhancement (LGE) and inflammatory biomarkers could predict the reversibility of CP after antiinflammatory therapy.Method and Results-Twenty-nine CP patients received antiinflammatory medications after cardiac magnetic resonance imaging. Fourteen patients had resolution of CP, whereas 15 patients had persistent CP after 13 months of follow-up. Baseline LGE pericardial thickness was greater in the group with reversible CP than in the persistent CP group (4 +/- 1 versus 2 +/- 1 mm, P=0.001). Qualitative intensity of pericardial LGE was moderate or severe in 93% of the group with reversible CP and in 33% of the persistent CP group (P=0.002). Cardiac magnetic resonance imaging LGE pericardial thickness >= 3 mm had 86% sensitivity and 80% specificity to predict CP reversibility. The group with reversible CP also had higher baseline C-reactive protein and erythrocyte sedimentation rate than the persistent CP group (59 +/- 52 versus 12 +/- 14 mg/L, P=0.04 and 49 +/- 25 versus 15 +/- 16 mm/h, P=0.04, respectively). Antiinflammatory therapy was associated with a reduction in C-reactive protein, erythrocyte sedimentation rate, and pericardial LGE in the group with reversible CP but not in the persistent CP group.Conclusions-Reversible CP was associated with pericardial and systemic inflammation. Antiinflammatory therapy was associated with a reduction in pericardial and systemic inflammation and LGE pericardial thickness, with resolution of CP physiology and symptoms. Further studies in a larger number of patients are needed. (Circulation. 2011;124:1830-1837.)