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Sleep apnea and morphofunctional aspects in patients with constrictive pericarditis undergoing pericardiectomy


Constrictive pericarditis is characterized by chronic inflammation of pericardium, which becomes thickened and calcified, leading to diastolic and systolic dysfunction. Its principal pathophysiological characteristics are restriction to ventricular filling, ventricular interdependence and low cardiac output. Thus, main features include a right heart failure syndrome and exertion dyspnea in the absence of significant pulmonary congestion. Previous reports suggest that in constrictive pericarditis there is a rising of plasma levels of NT-pro-BNP, cortisol, norepinephrine and rennin activity in conjunction with neuro-humoral and sympathetic activation, similar to other etiologies of heart failure. The relation between sleep disorders and heart failure is well described in literature, however, the pathophysiological mechanisms are not clear. It is postulated that upper airway edema, hyperventilation, pulmonary congestion with high capillary wedge pressure, delay in cardiopulmonary circulation and hyperactivation of sympathetic nervous system correlate with sleep disordered breathing. In this context, we believe that constrictive pericarditis, a potentially reversible cause of heart failure, is an interesting model to study the relation between cardiac hemodynamic and sleep disordered breathing, allowing new research perspectives. Objectives:The main objective of this study is to analyze the apnea/hypopnea index before and six months after pericardiectomy and to correlate it with measures of systolic and diastolic function and BNP levels. The secondary objectives are to study cardiopulmonary function and sympathetic activity before and after surgery. Methods: 15 patients undergoing pericardiectomy will be followed at UnidadeClínica de Miocardiopatiasdo Instituto do Coração - HC/FMUSP. The following tests will be performed before and six months after surgery: BNP, echocardiography, polysonography, cardiopulmonary test and microneurography. Data analysis and publication: the data will be submitted to statistical analysis and published in congresses and indexed journals. (AU)

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(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
PESSOA DE MELO, DIRCEU THIAGO; NERBASS, FLAVIA BAGGIO; CARRARI SAYEGH, ANA LUIZA; DE SOUZA, FRANCIS RIBEIRO; HOTTA, VIVIANE TIEMI; CURI SALEMI, VERA MARIA; ALVAREZ RAMIRES, FELIX JOSE; DIAS, RICARDO RIBEIRO; LORENZI-FILHO, GERALDO; MADY, CHARLES; FERNANDES, FABIO. Impact of pericardiectomy on exercise capacity and sleep of patients with chronic constrictive pericarditis. PLoS One, v. 14, n. 10 OCT 11 2019. Web of Science Citations: 0.

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