Researchers at Samsung Medical Center have published a new indicator that can predict the surgery outcome of constrictive pericarditis.
|Professors Oh Jae-gun (left) and Yang Jung-hoon|
The team, led by Professors Oh Jae-gun and Yang Jung-hoon, developed the new index after analyzing 113 patients who had undergone pericardiectomy to treat constrictive pericarditis between 2005 and 2013.
"A person's heart is wrapped in two layers of thin membranes (pericardium) that reduce friction with the outside, which increases and decreases along with the heart’s movement," the hospital said. "However, when the pericardium gets inflammation, it loses its elasticity and thickens."
In severe cases, the two separate layers can stick together and makes it hard for the heart to grow as the pericardium does not stretch and can lead to reduced blood flow to the heart, the hospital added. Currently, surgical removal of the inflamed pericardium is the primary treatment option for patients. However, the risks are high, and the prognosis is different, making it difficult to select patients for surgery.
To predict the prognosis, the team conducted an animal experiment and focused on the fact that the right atrium pressure and the pericardial pressure are almost identical. When the pericardium thickens and loses its elasticity, the pressure increases as the pressure increases in the right atrium.
The researchers put a catheter to the right of the heart of these patients to measure the pressure in the right atrium and also measured the pulmonary wedge pressure (PAWP). PAWP is a vital indicator of the left ventricle's ability to pump blood from the heart to the body.
According to the right atrial pressure (RAP) divided by PAWP (RAP/PAWP), the team found that perioperative thickness was directly proportional to patients who have removed their inflamed pericardium through surgery.
Based on these findings, the researchers divided the patients into two groups based on their median RAP/PAWP (0.77) and analyzed long-term survival.
As a result of a ten-year follow-up, the postoperative long-term survival rate was higher in the high RAP/PAWP group than in the low group.
"We have rediscovered the clinical implications of right ventricular surgery in constrictive pericarditis and suggested new indicators to predict patient prognosis," Professor Yang said.
The results of the research were published in the Journal of the American College of Cardiology.