Impact of pericardiectomy on exercise capacity and sleep of patients with chronic constrictive pericarditis

Autoři: Dirceu Thiago Pessoa de Melo aff001;  Flavia Baggio Nerbass aff002;  Ana Luiza Carrari Sayegh aff003;  Francis Ribeiro de Souza aff003;  Viviane Tiemi Hotta aff001;  Vera Maria Curi Salemi aff004;  Félix José Alvarez Ramires aff001;  Ricardo Ribeiro Dias aff005;  Geraldo Lorenzi-Filho aff002;  Charles Mady aff001;  Fábio Fernandes aff001
Působiště autorů: Cardiomyopathy Clinical Unit, Cardiology Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil aff001;  Sleep Laboratory, Pulmonary Divison, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil aff002;  Unit of Cardiovascular Rehabilitation and Exercise Physiology Cardiology Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil aff003;  Heart Failure Unit, Cardiology Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil aff004;  Unit of Cardiac Surgery, Cardiology Division, Heart Institute (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil aff005
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article



Heart failure is associated with exercise intolerance and sleep- disordered breathing; however, studies in patients with chronic constrictive pericarditis are scarce. The purpose of our study was to assess exercise capacity and sleep in patients with chronic constrictive pericarditis (CCP) undergoing a pericardiectomy.


We studied consecutive patients scheduled for pericardiectomy due to symptomatic CCP. Were performed quality of life (Minnesota Living with Heart Failure Questionnaire—MLHFQ) and sleep questionnaires (Epworth, Pittsburgh Sleep Quality Index—PSQI), serum B-type natriuretic peptide (BNP), serum C-reactive protein, transthoracic echocardiography, cardiopulmonary exercise test and overnight polysomnography immediately before and six months after pericardiectomy.


Twenty-five patients (76% males, age: 45.5±13.8 years, body mass index: 24.9±3.7 kg/m2, left ventricular ejection fraction: 60±6%) with CCP (76% idiopathic, 12% tuberculosis) were studied. As compared to the preoperative period, pericardiectomy resulted in reduction in BNP (143 (83.5–209.5) vs 76 (40–117.5) pg/mL, p = 0.011), improvement in VO2 peak (18.7±5.6 vs. 25.2±6.3 mL/kg/min, p<0.001), quality of life (MLHFQ score 62 (43,5–77,5) vs. 18 (8,5–22), p<0,001) and sleep (PSQI score 7.8±4.1 vs. 4.7±3.7, p<0.001) and no significant change in sleep disordered breathing (apnea hypopnea index—AHI 15.6 (8.3–31.7) vs. 14.6 (5.75–29.9) events/h, p = 0.253).


Patients with symptomatic CCP showed reduced exercise capacity and sleep-disordered breathing. After pericardiectomy, there was improvement in exercise capacity and neutral effect on sleep-disordered breathing.

Klíčová slova:

Echocardiography – Exercise – Heart failure – Quality of life – Sleep – Sleep disorders – Sleep apnea – Polysomnography


1. Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC) Endorsed by: The European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015;36(42):2921–64. doi: 10.1093/eurheartj/ehv318 26320112

2. Hancock EW. Differential diagnosis of restrictive cardiomyopathy and constrictive pericarditis. Heart. 2001;86(3):343–9. doi: 10.1136/heart.86.3.343 11514495

3. Balady GJ, Arena R, Sietsema K, Myers J, Coke L, Fletcher GF, et al. American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Peripheral Vascular Disease; Interdisciplinary Council on Quality of Care and Outcomes Research. Clinician's Guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation. 2010;122(2):191–225. doi: 10.1161/CIR.0b013e3181e52e69 20585013

4. Cohn JN, Johnson GR, Shabetai R, Loeb H, Tristani F, Rector T, Smith R, Fletcher R. Ejection fraction, peak exercise oxygen consumption, cardiothoracic ratio, ventricular arrhythmias, and plasma norepinephrine as determinants of prognosis in heart failure: the V-HeFT VA Cooperative Studies Group. Circulation. 1993;87(suppl):V-I5–V-16.

5. Mancini DM, Eisen H, Kussmaul W, Mull R, Edmunds LH Jr, Wilson JR. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation. 1991;83:778–786. doi: 10.1161/01.cir.83.3.778 1999029

6. Oldenburg O, Lamp B, Faber L, Teschler H, Horstkotte D, Töpfer V. Sleep-disordered breathing in patients with symptomatic heart failure: a contemporary study of prevalence in and characteristics of 700 patients. Eur J Heart Fail. 2007;9(3):251–7. doi: 10.1016/j.ejheart.2006.08.003 17027333

7. Bitter T, Westerheide N, Prinz C, Hossain MS, Vogt J, Langer C, et al. Cheyne-Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure. Eur Heart J. 2011;32(1):61–74. doi: 10.1093/eurheartj/ehq327 20846992

8. Pedrosa RP, Lima SG, Drager LF, Genta PR, Amaro AC, Antunes MO, et al.Sleep quality and quality of life in patients with hypertrophic cardiomyopathy.Cardiology. 2010;117(3):200–6. doi: 10.1159/000321718 21150200

9. Khayat R, Jarjoura D, Porter K, Sow A, Wannemacher J, Dohar R, et al.Sleep disordered breathing and post-discharge mortality in patients with acute heart failure.Eur Heart J. 2015;36(23):1463–9. doi: 10.1093/eurheartj/ehu522 25636743

10. Yumino D, Redolfi S, Ruttanaumpawan P, Su MC, Smith S, Newton GE, et al. Nocturnal rostral fluid shift: a unifying concept for the pathogenesis of obstructive and central sleep apnea in men with heart failure. Circulation. 2010;121(14):1598–605. doi: 10.1161/CIRCULATIONAHA.109.902452 20351237

11. Ling LH, Oh JK, Schaff HV, Danielson GK, Mahoney DW, Seward JB, et al. Constrictive pericarditis in the modern era: evolving clinical spectrum and impact on outcome after pericardiectomy. Circulation. 1999;100(13):1380–6. doi: 10.1161/01.cir.100.13.1380 10500037

12. Bertog SC, Thambidorai SK, Parakh K, Schoenhagen P, Ozduran V, Houghtaling PL, et al. Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy. J Am Coll Cardiol. 2004;43(8):1445–52. doi: 10.1016/j.jacc.2003.11.048 15093882

13. Klein AL, Abbara S, Agler DA, Appleton CP, Asher CR, Hoit B, et al. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr. 2013;26(9):965–1012. doi: 10.1016/j.echo.2013.06.023 23998693

14. Iber C, Ancoli-Israel S, Chesson A, Quan SF. The AASM Manual for the Scoring of Sleep and Associated Events: rules, terminology, and technical specifications, First Edition. Westchester, Illinois: American Academy of Sleep Medicine, 2007.

15. Carvalho VO, Guimarães GV, Carrara D, Bacal F, Bocchi EA.Validation of the Portuguese version of the Minnesota Living with Heart Failure Questionnaire.Arq Bras Cardiol. 2009;93(1):39–44. doi: 10.1590/s0066-782x2009000700008 19838469

16. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–5. doi: 10.1093/sleep/14.6.540 1798888

17. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213. doi: 10.1016/0165-1781(89)90047-4 2748771

18. Edelmann F, Wachter R, Schmidt AG, Kraigher-Krainer E, Colantonio C, Kamke W, et al. Effect of spironolactone on diastolic function and exercise capacity in patients with heart failure with preserved ejection fraction: the Aldo-DHF randomized controlled trial. JAMA. 2013;309(8):781–91. doi: 10.1001/jama.2013.905 23443441

19. Finocchiaro G, Haddad F, Knowles JW, Caleshu C, Pavlovic A, Homburger J, et al. Cardiopulmonary responses and prognosis in hypertrophic cardiomyopathy: a potential role for comprehensive noninvasive hemodynamic assessment. JACC Heart Fail. 2015;3(5):408–18. doi: 10.1016/j.jchf.2014.11.011 25863972

20. Yan J, Gong SJ, Li L, Yu HY, Dai HW, Chen J, et al. Combination of B-type natriuretic peptide and minute ventilation/carbon dioxide production slope improves risk stratification in patients with diastolic heart failure. Int J Cardiol. 2013;162(3):193–8. doi: 10.1016/j.ijcard.2011.07.017 21807423

21. Bitter T, Faber L, Hering D, Langer C, Horstkotte D, Oldenburg O. Sleep-disordered breathing in heart failure with normal left ventricular ejection fraction. Eur J Heart Fail. 2009;11(6):602–8. doi: 10.1093/eurjhf/hfp057 19468022

22. Gabor JY, Newman DA, Barnard-Roberts V, Korley V, Mangat I, Dorian P, et al. Improvement in Cheyne-Stokes respiration following cardiac resynchronisation therapy. Eur Respir J. 2005;26(1):95–100. doi: 10.1183/09031936.05.00093904 15994394

23. Bucca CB, Brussino L, Battisti A, Mutani R, Rolla G, Mangiardi L, et al. Diuretics in obstructive sleep apnea with diastolic heart failure. Chest. 2007;132(2):440–6. doi: 10.1378/chest.07-0311 17699130

24. Kim JS, Ha JW, Im E, Park S, Choi EY, Cho YH, et al. Effects of pericardiectomy on early diastolic mitral annular velocity in patients with constrictive pericarditis. Int J Cardiol. 2009;133(1):18–22. doi: 10.1016/j.ijcard.2007.11.064 18234366

25. Veress G, Ling LH, Kim KH, Dal-Bianco JP, Schaff HV, Espinosa RE, et al. Mitral and tricuspid annular velocities before and after pericardiectomy in patients with constrictive pericarditis. Circ Cardiovasc Imaging. 2011;4(4):399–407. doi: 10.1161/CIRCIMAGING.110.959619 21543641

26. Kusunose K, Dahiya A, Popović ZB, Motoki H, Alraies MC, Zurick AO, et al. Biventricular mechanics in constrictive pericarditis comparison with restrictive cardiomyopathy and impact of pericardiectomy. Circ Cardiovascular Imaging. 2013;6:399–406. doi: 10.1161/CIRCIMAGING.112.000078 23532508

27. Senni M, Redfield MM, Ling LH, Danielson GK, Tajik AJ, Oh JK.Left ventricular systolic and diastolic function after pericardiectomy in patients with constrictive pericarditis: Doppler echocardiographic findings and correlation with clinical status.J Am Coll Cardiol. 1999;33(5):1182–8. doi: 10.1016/s0735-1097(98)00693-7 10193714

28. Culliford AT, Lipton M, Spencer FC. Operation for chronic constrictive pericarditis: do the surgical approach and degree of pericardial resection influence the outcome significantly? Ann Thorac Surg. 1980;29:146–52. doi: 10.1016/s0003-4975(10)61653-0 7356365

29. Levine HD. Myocardial fibrosis in constrictive pericarditis: electrocardiographic and pathologic observations. Circulation. 1973;48:1268–81. doi: 10.1161/01.cir.48.6.1268 4762484

Článek vyšel v časopise


2019 Číslo 10
Nejčtenější tento týden