Diagnostic challenge in constrictive pericarditis: the role of brain natriuretic peptide and image tools

Myocardial and pericardial diseases diac Magnetic Resonance Imaging (MRI) at baseline and at nine months followup. The secondary end-points were change in Flow Mediated Dilatation (FMD) and Augmentation Index (AIx). Results: Allopurinol significantly reduced absolute LVM (-2.65±5.91g and placebo group +1.21±5.10g (p=0.012)) and LVMI (indexed) to body surface area (-1.32±2.84g/m2 and placebo group +0.65±3.07g/m2 (p=0.017)). No significant change was seen in either FMD or AIx. Allopurinol induced LVH regression was however concentrated in those with an above median LV mass at baseline, as might be expected, as shown in Figure 1. Figure 1 P3891 | BEDSIDE Predictors of reversibility in constrictive pericarditis patients M.C. Alraies 1 , U. Tariq 1 , W. Aljaroudi 2 , A.L. Klein 1 . 1 Cleveland Clinic, Department of Cardiovascular Medicine, Cleveland, United States of America; 2 American University of Beirut, Beirut, Lebanon Background: Constrictive pericarditis is a debilitating disease and reversible constriction is a well-described phenomenon. However, factors which predict reversibility remain unknown. No study has shown factors that might predict reversibility and thus preclude these patients from pericardiectomy which has its own host of debilitating sequelae. In this study we sought to look into factors which predict constriction reversibility in CP patients. Method: We evaluated 48 consecutive patients who developed CP following the first attack of pericarditis in year 2011. All patients were treated with NSAIDs, colchicine and steroids as first treatment. Demographics, etiology, laboratory, echocardiograpic and outcome data were collected retrospectively using electronic medical record offline echocardiograms films. Results: 27 patients had reversibly constriction with medical therapy only and 19 patients underwent pericardiectomy who were identified as irreversible. Those who had surgery had normal inflammatory marker (ERS, 11.8±7 vs. 40±25, CRP 2.5±2 vs. 6.9±3.1, p=0.001), more septal bounce (17 vs. 7, p=0.001), and more dilated inferior vena cava (2.69±0.4 vs. 2.12±0.35, p=0.001) and less inspiratory collapse (3 vs. 20, p=0.001). Furthermore, patient who had surgery had thicker pericardium on echo confirmed with cardiac MRI (0.74 vs. 0.45 vs. 0.41±0.5, p=0.28). Using tissue doppler, septal and lateral E/e’ were higher among those who had reversible disease (11.36±4.8 vs. 7.25±1.9 p=0.001 and 9.8±3.9 vs. 5.9±2.4, p=0.001), respectively. On multivariate analysis, septal bounce correlated with need for surgery (p<0.05). High ESR and high E/e’ lateral correlated with resolution (p<0.05). Conclusion: In CP, pericardiectomy can be the ultimate treatment in advanced cases. In few cases CP can be reversible and respond to medical therapy only. In this study we identified septal bounce, increased pericardial thickness, and normal inflammatory markers as predictors for pericardiectomy, which represent less inflammation and more fibrosis as pathology of pericardial constriction. On the other hand, higher inflammatory markers, and mitral valve annular velocity, as predictors for reversibility and potential to response to medical therapy. Knowing features that describe reversible disease will be helpful in pursuing aggressive medical management for those who will benefit and avoiding unnecessary surgery. P3892 | BEDSIDE Allopurinol regresses left ventricular hypertrophy especially in those with highest left ventricular mass B.R. Szwejkowski 1 , S.J. Gandy 2 , S.J. Rekhraj 1 , G. Houston 1 , C.C. Lang 1 , A.D. Morris 1 , J. George 1 , A.D. Struthers 1 . 1 University of Dundee, Dundee, United Kingdom; 2 Ninewells Hospital, Dundee, United Kingdom Aims: Left Ventricular Hypertrophy (LVH) is common in Type 2 Diabetes (T2DM) and contributes to their high Cardiovascular (CV) event rate. LVH can be related to Oxidative Stress (OS) and allopurinol reduces OS. We therefore investigated whether allopurinol regresses LVH in patients with T2DM. Methods: We conducted a randomised, double blind, placebo controlled study in 66 T2DM patients with echocardiographic evidence of LVH. Allopurinol 600mg/day or placebo was given for nine months over the study period. The primary outcome was reduction in Left Ventricular Mass (LVM) as calculated by car- Conclusion: Allopurinol regresses LVM in patients with T2DM and LVH. Importantly the effects of allopurinol on regression of LVM was more marked in the cohort with above median baseline LVM. Regressing LVH has been shown previously to improve CV mortality and morbidity. Therefore allopurinol may become a useful therapy to reduce CV events in T2DM patients with LVH and patients with more marked LVH may have more to gain P3893 | BEDSIDE Diagnostic challenge in constrictive pericarditis: the role of brain natriuretic peptide and image tools D.T.P. Melo 1 , F. Fernandes 1 , V.M.C. Salemi 1 , P.C. Buck 1 , R.R. Dias 2 , M.G. Tiveron 2 , C. Mady 1 . 1 Heart Institute (InCor) - HC-FMUSP, Cardiomyopathies Unit, Sao Paulo, Brazil; 2 Heart Institute (InCor) - HC-FMUSP, Department of Cardiac Surgery, Sao Paulo, Brazil Background: Constrictive pericarditis (CP) is characterized by chronic pericardial inflammation, leading to fibrosis and restriction to the filling of cardiac chambers. CP’s pathophysiological landmarks are ventricular interdependence, respiratory variations of tricuspide and mitral flow and low cardiac output. Due to CP’s low prevalence and peculiar clinical presentation constrictive pericarditis is commonly unsuspected, leading to misdiagnosis of other causes of heart failure, hepatic and pulmonary diseases. The aim of this study was to assess the role of clinical signs, brain natriuretic peptide (BNP) and image tools in patients with surgically proven constrictive pericarditis. Methods: We retrospectively analyzed 33 patients who underwent pericardiectomy for CP in a single center from 2003 to 2012. Constrictive pericarditis diagnosis was confirmed in surgical report. Results: Mean age was 43±15 years with predominance of men (82%). CP etiology was idiopatic in 24 patients (72.7%), tuberculosis in 7 (21.2%) and post cardiac surgery in 2 (6,1%). Limiting symptoms, defined by New York Heart Association functional class III/IV, were present in 26 (78.7%). Mean BNP (obtained in 22 patients) was 170±100 (range 37-468 pg/ml) and in only one patient was more than 400 pg/ml. Other common findings were jugular venous distention (91%), peripheral edema (84.8%), ascites (63.3%), pleural effusion (39.3%), pericardial calcification in chest radiograph (30.3%), pericardial knock (24.2%), paradoxical pulse (15.1%) and kussmaul sign (15.1%). Transthoracic echocardiogram (TE) and cardiac magnetic resonance imaging (MRI) had good specificity (100%) but different sensibility (63.3 vs 93%, respectively). MRI showed thickened pericardium (≥ 4mm) in 26 patients (78.7%), septal bounce in 29 (87.7%) and dilated inferior vena cava in 31 (93%). All the patients u (...truncated)