Dressler's Syndrome Research Articles

Partial versus Complete Sternotomy for Aortic Valve Replacement—Multicenter Study

Abstract Background The benefits of minimally invasive techniques in cardiac surgery remain poorly defined. We evaluated the short- and mid-term outcomes after surgical aortic valve replacement through partial upper versus complete median sternotomy (MS) in a large, German multicenter cohort. Methods A total of 2,929 patients underwent isolated surgical aortic valve replacement via partial upper sternotomy (PUS, n = 1,764) or MS (n = 1,165) at nine participating heart centers between 2016 and 2020. After propensity-score matching, 1,990 patients were eligible for analysis. The primary end point was major adverse cardiac and cerebrovascular events (MACCE), a composite of death, myocardial infarction, and stroke at 30 days and in follow-up, up to 5 years. Secondary end points were acute kidney injury, length of hospital stay, transfusions, deep sternal wound infection, Dressler's syndrome, rehospitalization, and conversion to sternotomy. Results Unadjusted MACCE rates were significantly lower in the PUS group both at 30 days (p = 0.02) and in 5-year follow-up (p = 0.01). However, after propensity-score matching, differences between the groups were no more statistically significant: MACCE rates were 3.9% (PUS) versus 5.4% (MS, p = 0.14) at 30 days, and 9.9 versus 11.3% in 5-year follow-up (p = 0.36). In the minimally invasive group, length of intensive care unit (ICU) stay was shorter (p = 0.03), Dressler's syndrome occurred less frequently (p = 0.006), and the rate of rehospitalization was reduced significantly (p < 0.001). There were 3.8% conversions to full sternotomy. Conclusion In a large, German multicenter cohort, MACCE rates were comparable in surgical aortic valve replacement through partial upper and complete sternotomies. Shorter ICU stay and lower rates of Dressler's syndrome and rehospitalization were in favor of the partial sternotomy group.

Considerations in Dressler Syndrome: A Comprehensive Review

Dressler Syndrome, also known as post-myocardial infarction syndrome, is a rare but potentially serious complication that occurs following myocardial infarction or cardiac surgery. It is characterized by pericarditis, pleuritis, and fever, typically presenting weeks to months after the initial event. This article provides a comprehensive review of Dressler Syndrome, including its pathophysiology, clinical presentation, diagnosis, and management. Additionally, it discusses the importance of early recognition and appropriate treatment to prevent complications and improve outcomes.

Postcardiac Injury Syndrome After Cardiac Surgery: An Evidence-Based Review.

Postcardiac injury syndrome (PCIS) serves as a comprehensive term encompassing a spectrum of conditions, namely postpericardiotomy syndrome, postmyocardial infarction (MI) related pericarditis (Dressler syndrome), and post-traumatic pericarditis stemming from procedures like percutaneous coronary intervention or cardiac implantable electronic device placement. These conditions collectively give rise to PCIS, triggered by cardiac injury affecting pericardial or pleural mesothelial cells, leading to subsequent inflammation syndromes spanning from uncomplicated pericarditis to substantial pleural effusion. A thorough literature search conducted on MEDLINE/PubMed utilizing search terms including "postacute cardiac injury syndrome," "postcardiac injury syndrome," "postcardiotomy syndrome," "postpericardiotomy syndrome," and "post-MI pericarditis" was instrumental in collating pertinent studies. To encapsulate the amassed evidence, relevant full-text materials were meticulously selected and amalgamated narratively. The pathophysiology of PCIS is proposed to manifest through an autoimmune-mediated process, particularly in predisposed individuals. This process involves the development of anti-actin and antimyosin antibodies after a cascade of cardiac injuries in diverse forms. Treatment strategies aimed at preventing recurrent PCIS episodes have shown efficacy, with colchicine and nonsteroidal anti-inflammatory drugs, including ibuprofen, demonstrating positive outcomes. Conversely, corticosteroids have exhibited no discernible benefit concerning prognosis or recurrence rates for this ailment. In summary, PCIS serves as a unifying term encompassing a spectrum of cardiac injury-related syndromes. A comprehensive review of relevant literature underscores the autoimmune-mediated pathophysiology in susceptible individuals. The therapeutic landscape involves the proficient use of colchicine and Nonsteroidal anti-inflammatory drugs to deter recurrent PCIS episodes, while corticosteroids do not appear to contribute to improved prognosis or reduced recurrence rates. This nuanced understanding contributes to an enhanced comprehension of PCIS and its multifaceted clinical manifestations, potentially refining its diagnosis and management.

A case report of left circumflex stent infection and mycotic aneurysm: a rare but life-threatening complication of percutaneous coronary intervention

BackgroundCoronary stent infections are an uncommon but deadly complication of percutaneous coronary intervention. Mortality remains as high as 40–60% even with adequate treatment. We report such an interesting case of left circumflex stent (LCX) infection and mycotic aneurysm that was successfully managed with antibiotics and surgery.Case presentationA middle-aged man who underwent percutaneous coronary intervention (PCI) to the left circumflex artery four weeks prior was referred as a case of pyrexia of unknown origin, not responding to antibiotics, and colchicine started for suspected Dressler syndrome. Although the inflammatory markers were elevated, the results of the blood culture did not show any growth. Echocardiography showed a doubtful echogenic structure in the left atrioventricular groove and mild pericardial effusion, and a stent infection was suspected. PET scan showed focal metabolic activity in the region of the LCX stent, with metabolically active supraclavicular and paratracheal lymph nodes, and a coronary angiogram revealed an aneurysm arising distal to the stented LCX. A diagnosis of stent infection and associated mycotic aneurysm was made, and the patient underwent surgery which included aneurysm repair, stent retrieval, and coronary artery bypass graft (CABG) to the major and terminal OM. The postoperative course was uneventful, and the patient was discharged without complications.ConclusionsIt is important to investigate the possibility of coronary stent infection in individuals experiencing prolonged fever following PCI. PET scans and coronary angiograms can aid in diagnosis when echocardiograms are inconclusive. Adequate antibiotic therapy and timely surgery are crucial for successfully managing coronary stent infections.

Аутоиммунный постинфарктный синдром

The purpose — to present a clinical case of diagnosing the autoimmune postinfarction syndrome (Dressler syndrome). Material and methods. The medical documentation of a patient with myocardial infarction complicated by Dressler syndrome was analyzed. Results. The clinical case presents a patient with acute extensive anterior myocardial infarction who sought medical help on the 2nd day of the disease, which may have caused the autoimmune postinfarction syndrome on the 11th day of the disease (fibrinous exudative pericarditis, focal pneumonia, eosinophilia and laboratory signs of inflammation). The patient’s low adherence to the treatment during hospitalization contributed to the subsequent development of coronavirus infection. Conclusion. The publication is of interest to cardiologists, doctors of functional and radiation diagnostics. The diagnosis of Dressler syndrome is based mainly on the results of laboratory and instrumental research methods as the onset and course of Dressler syndrome most often has a poor clinical picture.

Case Report of Dressler Syndrome and Left Ventricular Aneurysm in a 47-Year-Old Male with Diabetes

We present a case report of a 47-year-old male with a known history of recent diabetes who presented with symptoms suggestive of Dressler syndrome, along with the incidental finding of a left ventricular aneurysm. Dressler syndrome is a delayed immune-mediated response following myocardial injury, commonly observed post-myocardial infarction (MI) or cardiac surgery. This case highlights the importance of recognizing the atypical presentation of Dressler syndrome and its association with complications such as ventricular aneurysm, particularly in patients with pre-existing comorbidities.

The impact of statin use before intensive care unit admission on patients with acute kidney injury after cardiac surgery.

Background: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common and serious complication after cardiac surgery. The influence of statin use before surgery on the renal outcome of patients undergoing cardiac surgery is controversial. The purpose of this study was to evaluate the effect of statins on postoperative renal outcomes in patients undergoing cardiac surgery. Methods: We included CSA-AKI patients in the Medical Information Mart for Intensive Care (MIMIC)-IV database and were divided into statin group and non-statin group according to whether they used statins before entering intensive care units (ICU). The main outcomes were hospitalization and 30-day mortality, and the secondary outcomes were 60-day mortality and 90-day mortality. We used propensity score matching (PSM) to adjust for confounding factors. The 95% confidence interval (CI) and risk ratio (RO) were calculated by the COX proportional regression model. At the same time, stratified analysis was used to explore whether the relationship between the statins use before intensive care units and mortality was different in each subgroup and whether the relationship between different doses of Atorvastatin and mortality was different. Result: We identified 675 pre-ICU statin users and 2095 non-statin users. In the COX proportional regression model, pre-ICU statin use was associated with decreased in-hospital (HR = 0.407, 95%confidence interval 0.278-0.595, p < 0.001) and 30-day mortality (HR = 0.407, 95%CI 0.279-0.595, p < 0.001). The survival rate of patients who took statins before entering ICU was significantly higher than that of those who did not use statins at 30days, 60days and 90days. There is a significant interaction between patients with aged>65years (HR = 0.373, 95%CI 0.240-0.581, p < 0.001), Acute kidney injury grade I (HR = 0.244, 95%CI 0.118-0.428, p < 0.001), and without post-myocardial infarction syndrome (HR = 0.344, 95%CI 0.218-0.542, p < 0.001). The mortality in hospital and 60days of CSA-AKI patients treated with ≥80mg Atorvastatin before operation was significantly reduced (p < 0.05). Conclusion: The pre-ICU statin use was significantly associated with decreased risk in hospital and 30-day mortality. The preoperative use of ≥80mg Atorvastatin may improve the prognosis of CSA-AKI.

Post-Cardiac Injury Syndrome (Dressler Syndrome) Following Atrial Septal Defect (ASD) Repair: a Case Report

Dressler syndrome is a type of secondary pericarditis that can be accompanied by pleural effusion or pericardial effusion resulting from injury of the pericardium or heart tissue. A 33-year-old male was admitted to the emergency department with pleuritic chest pain radiating to both shoulders and fever. Two months before the admission, the patient underwent traditional open-heart surgery with median sternotomy and pericardiectomy for atrial septal defect (ASD) closure. Blood tests showed elevated acute phase reactants (leukocytosis, high erythrocyte sedimentation rate, and C-reactive protein). Left-sided pleural effusion was revealed on chest CT scan. Diagnosis of Dressler syndrome was established. The patient’s pleuritic chest pain and shoulder pain improved clinically with a short course of colchicine. Although Dressler syndrome is rarely seen, it should be considered in the differential diagnosis of pleuritic chest pain. Special attention should be paid to Dressler’s syndrome because pericarditis can develop following cardiac surgery.

Dressler syndrome after myocardial infarction: a case report

Dressler syndrome after myocardial infarction: a case report

Dressler syndrome: a literature review

Gabrielė Žūkaitė1, Rasa Šimoniūtytė2 1Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lithuania 2Vilnius City Clinical Hospital, Department of Internal Medicine, Vilnius, Lithuania Abstract Background. Dressler syndrome (DS) occurs as a result of injury to the heart or pericardium, usually 1 to 6 weeks after a myocardial infarction. The incidence is decreasing due to advanced treatment methods. Pathogenesis still remains unclear, but it is associated with autoimmune processes. Clinical DS symptoms are fever, pleuritic chest pain, and fluid in pericardial and/or pleural space (pericardial rub and murmurs may be heard). Aim: to select and analyze the latest diagnostic and treatment recommendations for DS based on the experience of researchers and to discuss the etiology, pathogenesis and clinical symptoms. Material and methods. A review of medical literature was performed using databases of PubMed, Elsevier, Google Scholar, and guidelines of European Society of Cardiology. The search was performed using the following keywords and combinations in English: Dressler syndrome, pericarditis, post-cardiac injury syndrome. Results. DS can be diagnosed if two of the five diagnostic criteria are present (fever without other alternative causes, pericardial or pleural pain, pericardial or pleural effusion, fluid in pericardium or pleura, and/or increased C-reactive protein). The first-line treatment is non-steroidal anti-inflammatory drugs in combination with colchicine. In treatment-resistant DS, glucocorticoids are given without discontinuing colchicine. If recovery is not achieved even with second-line treatment, immunomodulators or intravenous immunoglobulin are prescribed, and as a last resort, pericardiectomy is performed. Conclusion. DS has favorable prognosis if diagnosed in time, but there is a possibility of recurrence of the syndrome (colchicine is an approved medication for prevention). Keywords: Dressler syndrome, pericarditis, post–cardiac injury syndrome. Full article https://doi.org/10.53453/ms.2023.2.20

Twenty-year changes in the clinical and echocardiographic characteristics of patients with early postinfarction remodeling after primary ST-segment elevation myocardial infarction

Aim. To compare structural and functional left ventricular (LV) changes in the early period of myocardial infarction (MI) within 20 years on the basis of the Emergency Cardiology Department of the Cardiology Research Institute (Tomsk).Material and methods. The study included two groups of patients who were treated at different periods of time with an interval of 20 years. Group 1 included 83 patients who had ST-segment elevation MI (STEMI) in 1997-1999, while group 2 — 83 patients with STEMI from 2019-2020. Echocardiography was performed during the first 72 hours from hospitalization and on the 7-10th day. Depending on the increase in LV end-diastolic volume (EDV) by &gt;15% by the 7-10th day, the patients were divided into 2 subgroups: with remodeling (LVR+) and without remodeling (LVR-).Results. Patients of the 2nd group were older, with a larger proportion of females and with a high incidence of risk factors for coronary artery disease compared with patients of the 1st group. In the early postinfarction period among patients of the 2nd group, acute LV aneurysm, early postinfarction angina and Dressler syndrome developed less frequently. The proportion of adverse LV remodeling in patients of the 1st group was higher (32,8% vs 17%), and while the percentage of reverse remodeling was lower (10% vs 24%), p&lt;0,05. Comparison of the absolute values of LV EDV, end-systolic volume (ESV) and ejection fraction (EF) at baseline and after 7 days, as well as their increase showed higher intensity of post-infarction remodeling in group 1 patients. In patients of the 1st group, there was a progression of LV remodeling (Me ΔEDV — 12,2%) with a deterioration in LV contractility by the 7th day (Me ΔESV — 14%), while in patients of the 2nd group during the first 7 days of MI, there were more stable LV EDV and ESV (p&gt;0,05) and an increase in LVEF (p=0,03) before discharge.Conclusion. In the present era of primary percutaneous coronary intervention and pharmacological treatment of MI, early adverse LV remodeling develops less frequently and is characterized by less pronounced left heart dilatation.

Синдром Дресслера

The purpose is to present a literature review on a rather rare pathology — Dressler syndrome, paying special attention to one of its main components — pericarditis. Material and methods. Russian and foreign literature on Dressler syndrome were studied, with special attention to the sources over the recent 10 years. Results. A review of the medical literature on the topic — Dressler syndrome is presented, describing the concept, etio-pathogenetic aspects, classification, epidemiology, a brief historical background, clinical picture, laboratory and instrumental features, and tactics of patient management. Conclusion. Dressler syndrome is understood as a symptom complex that occurs due to myocardial damage of various genesis with the development of autoimmune aggression and subsequent hyperergic reaction with benign lesion of serous membranes, leading to the appearance of pericarditis, pleurisy, pneumonitis and other symptoms. The initial clinical manifestations and the subsequent course of this syndrome, as a rule, are often unexpressed. Therefore, a timely assessment of clinical and instrumental data that go beyond the usual course of the post-infarction / postoperative period, as well as the effect of the therapy used, contributes to the timely diagnosis of this syndrome and, accordingly, the appointment of adequate pathogenetic therapy.

448 ACUTE IDIOPATHIC PERICARDITIS: THE IMPORTANCE OF GUIDELINE-BASED TREATMENT TO AVOID RECURRENCE

Abstract Background Acute pericarditis usually resolves with first-line treatment, but it may recur. Recurrences are usually attributed to a deranged immunity, but it is unclear whether they may also be related to inappropriate treatment. Purpose The aims of our study were to clarify the potential role of inappropriate treatment on relapse episodes in acute pericarditis. Methods Consecutive patients prospectively followed-up for over 20 years at Padua University Cardioimmunology outpatient clinic were included. Clinical and instrumental findings were recorded at diagnosis and at each follow-up. Spectrum, appropriateness, efficacy and side effects of therapies received by patients before and after referral to our centre were considered. The distribution of recurrence-free survival probability has been estimated using Kaplan-Meier method; impact of the covariates of interest on the outcome was assessed using Cox univariate analysis models. Results The cohort consisted of 144 patients (82 males, 62 females, mean age 50 years, 143 Caucasian and 1 African), 139 had acute pericarditis, which was recurrent in 63; 5 had constrictive pericarditis; aetiology was idiopathic/presumed-viral in 112, bacterial in 1, secondary to pericardial injury in 26, to Dressler syndrome in 2, and to a systemic immune-mediated disease in 3. At diagnosis, 68% were in NYHA class I, 22% in II, 5% in III, 5% in IV; 9% developed cardiac tamponade; 84% patients received non-steroidal-anti-inflammatory drugs, 54% colchicine and 19% corticosteroids. Treatment was not in line with ESC guidelines in 31% of patients for non-steroidal-anti-inflammatory drugs, in 12% for steroids and in 28% for colchicine, requiring readjustment. Patients with constrictive pericarditis underwent uncomplicated pericardiectomy. No patient was dead at last follow-up. Estimated recurrence-free-survival probability was 86% at 1st year, 58% at 5th, 52% at 10th. Variables which tended to be associated with a higher risk of recurrence were: cardiac tamponade at diagnosis, left heart failure, concomitant immuno-mediated diseases, specific etiology, history of recurrence, inappropriate treatment with colchicine, inappropriate treatment with non-steroidal anti-inflammatory-drugs, III or IV NYHA class at diagnosis. Treatment of acute/recurrent forms before referral did not appear in line with the international recommendations in terms of daily dosage and duration, or both, in 43 patients for anti-inflammatory drugs, in 17 for corticosteroids and in 39 for colchicine, which was omitted despite the absence of known contraindications (see attached Table). Following treatment adjustment to international guidelines, 107 patients with relapsing pericarditis obtained complete remission; only 13 (9%) of our AP patients showed a truly treatment-refractory form that required a second-line therapy. All patients (5) with constrictive pericarditis underwent uncomplicated pericardiectomy. Conclusion When treated according to international guidelines, pericarditis has usually a favourable evolution, even in its most adverse presentations. Treatment inaccuracies seems to account, at least in part, to disease recurrences.

Bilateral pleural effusion: etiology, diagnostics

The problem of etiologic diagnosis of bilateral pleural effusions is important because of the relatively large number and variety of diseases accompanied by this syndrome, the complexity of diagnosis verification, and the frequent diagnostic errors. The aim of this review is to describe the spectrum of diseases causing bilateral pleural effusion and to consider a set of diagnostic measures to clarify the etiology of the process. Analysis of 60 literature sources showed that the most common causes of bilateral transudative pleural effusions are cardiac, hepatic, and renal insufficiency. Exudative bilateral pleural effusions are found in inflammatory processes in the pleura, including tuberculosis, and develop when inflammation is transmitted by contact or lymphohematogenous routes from the lungs or other organs. Bilateral localization of pleural effusion in tumor processes is observed in 5.7% of cases. Bilateral pleural effusion is seen in pulmonary embolism, diffuse connective tissue diseases, acute idiopathic pericarditis, postinfarction Dressler syndrome, after pericardotomy, and after pacemaker placement. It may be observed in such rare diseases as sarcoidosis, yellow nail syndrome, and Meigs syndrome, and may be induced by some drugs. Conclusion. The choice of therapeutic measures for bilateral pleural effusion is determined by an accurate etiological diagnosis of the underlying disease. The diagnosis should be based on the patient's clinical data and cytologic, microbiologic, and biochemical analysis of pleural fluid obtained by pleural puncture. In some cases, additional examination methods such as pleural biopsy, bronchoscopy, ultrasound, computed, magnetic resonance imaging of the chest and abdomen, and positron emission tomography are required.

Acute idiopathic pericarditis: the importance of guideline-based treatment to avoid recurrence

Abstract Background Acute pericarditis (AP) usually resolves with first-line treatment, but it may recur. Recurrences are attributed to a deranged immunity, but it is unclear if they may also be related to inappropriate treatment. Purpose The aim of our study was to clarify the potential role of inappropriate treatment on relapse episodes in AP. Methods Consecutive patients prospectively followed-up over 20 years at Padua University Cardio-immunology outpatient clinic were included. Clinical and instrumental findings were recorded at diagnosis and at each follow-up. Spectrum, appropriateness, efficacy and side effects of therapies received by patients before and after referral to our centre were considered. The distribution of recurrence-free survival probability was estimated using Kaplan-Meier method; impact of the covariates of interest on the outcome was assessed using Cox univariate analysis models. Results The study included 144 patients (57% male, mean age 50 years, 143 Caucasian and 1 African). 139 patients had AP, which was recurrent in 63; 5 had constrictive pericarditis. Etiology was idiopathic/presumed-viral in 112 patients, bacterial in 1, secondary to pericardial injury in 26, to Dressler syndrome in 2, and to a systemic immune-mediated disease in 3. At diagnosis, 68% were in NYHA class I; 9% developed cardiac tamponade; 84% received non-steroidal-anti-inflammatory drugs (NSAIDs), 54% colchicine and 19% corticosteroids. Treatment was not in line with ESC guidelines in 31% of patients for NSAIDs, in 12% for steroids and in 28% for colchicine, requiring readjustment. All patients with constrictive pericarditis underwent uncomplicated pericardiectomy. No patient was dead at last follow-up. Estimated recurrence-free-survival probability was 86% at 1st year, 58% at 5th, 52% at 10th. Variables which tended to be associated with a higher risk of recurrence were: cardiac tamponade at diagnosis, left heart failure, concomitant immune-mediated diseases, history of recurrence, inappropriate treatment with colchicine, inappropriate treatment with NSAIDs, III or IV NYHA class at diagnosis. Treatment of acute/recurrent forms before referral did not appear in line with the international recommendations in terms of daily dosage or duration, or both, in 43 patients for NSAIDs, in 17 for corticosteroids and in 39 for colchicine, which was omitted despite the absence of contraindications (Table 1). Following treatment adjustment to international guidelines, 107 patients with relapsing pericarditis obtained complete remission; only 13 (9%) of our AP patients showed a truly treatment-refractory form that required a second-line therapy. Conclusion When treated according to international guidelines, pericarditis has usually a favorable course, even in its most adverse presentations. Treatment inaccuracies seems to account, at least in part, to disease recurrences. Funding Acknowledgement Type of funding sources: None.

Diaphragmatic Hernia after Thoracoabdominal Trauma - Laparoscopic Surgical Repair with Mesh

Traumatic diaphragmatic hernia (TDH) is an uncommon disease, with an incidence of about 0.5% and is usually associated with penetrating or blunt thoracoabdominal trauma (1). It is often associated with other thoracoabdominal, brain and musculoskeletal injuries, being a diagnostic and therapeutic challenge (2). These injuries worsen the prognosis, with a mortality of up to 31% (2, 3). Chest X-rays with bowel contrast studies and CT scans of the chest and the abdomen are a useful diagnostic tool for detecting TDH, being the latter more specific (4). The treatment involves repair of the diaphragmatic defect with or without a mesh, using a transthoracic and/or transabdominal approach (1). The recurrence of diaphragmatic hernia can occur due to primary hernia repair without tension-free suture, incorrect attachment of the mesh without the necessary overlap or failure in the host-prosthesis interface (5). Hanna WC et al. demonstrated that recurrence may also be related to the use of absorbable suture to close the defect (4). The aim of this video is to illustrate the key steps for the surgical technique of a recurrent diaphragmatic hernia repair with mesh through laparoscopic approach. We present a 20-year-old male with a history of hereditary hyperferritinemia and hypertension. In 2019, due to a car accident, he suffered multiple traumas including rib fractures, descending aortic dissection, hemothorax, hemoperitoneum, and diaphragmatic laceration with the migration of the stomach to an intrathoracic position. The patient underwent thoracotomy, replacing the descending aorta isthmus with a graft, suture of the diaphragm defect, and chest drainage. Later, due to complications, he was hospitalized with a post-pericardiotomy syndrome – Dressler's syndrome - with pericardial and pleural effusion. He had a recurrence of the diaphragmatic hernia in 2021, initially small and asymptomatic, later increasing in size and becoming symptomatic. The thoraco-

390 Late pleuro-pericardial effusion after atrial fibrillation radiofrequency ablation

Abstract Aims Post-cardiac injury syndrome (PCIS) is an inflammatory state involving pericardium, epicardium, and myocardium causing a clinical picture in which epicardial and pericardial symptoms are prevalent. It appears mediated by autoimmune mechanisms and may appear as late post myocardial infarction pericarditis (Dressler’s Syndrome) or as a post traumatic pericarditis in the case of spontaneous thoracic trauma or iatrogenic pericarditis. Apart from the acute setting, pericardial effusion can be a manifestation of PCIS after interventional procedures. Methods and results A 57 years old hypertensive woman suffering from recurrent atrial fibrillation episodes underwent a technically difficult radio-frequency catheter ablation because of complex pulmonary veins anatomy and wide scar in the left atrial wall. During the procedure she developed cardiac tamponade and 410 ml of blood were drained by pericardiocentesis and re-infused without recurrent pericardial effusion during further in-hospital stay. She was discharged on apixaban 5 mg b.i.d. with Hb value of 10.2 g/dl. Two weeks later the patient was hospitalized for worsening cough, atypical chest pain, dyspnoea and modest orthopnea. C-reactive protein levels were 8.7 mg/dl, Hb was 9.9 g/dl and platelet count 484 000/ml; blood cultures were negative. An urgent thoracic CT scan showed bilateral pleural effusion and ubiquitous pericardial effusion (2.5–3 cm), without signs of active bleeding from the cardiac chambers into the pericardium. After stopping apixaban, the patient was given colchicine (1 mg/die). A total of 1200 ml of hematic pericardial fluid was drained from the pericardium over a 5-day period. Autoimmune blood tests were negative, as well as antibodies to pericardiotropic viruses. Pericardial fluid was negative for quantiferon and direct BK. On day 9, the drain was removed and steroidal treatment was started (prednisone 25 mg/die with scheduled tapering). Further echocardiographic exams were stable without pericardial effusion; a chest X-ray scan (at day 16) showed reversal of the water bottle shaped heart and of the pleural effusion. Conclusions Early myocardial infarct-associated pericarditis and Dressler’s syndrome account for about 20% of cases of PCIS accompanied by symptoms of epicardial and pericardial origin. PCIS is quite common after cardiac surgery, but it may be also observed even after iatrogenic trauma occurring during cardiac interventions: PCI, pacemaker lead insertion, radiofrequency ablation and Swan–Ganz catheterization. Blood entering the pericardium is thought to play a pivotal etiological role in iatrogenic PCIS, with consequent huge inflammatory reaction in the mesothelial tissue resulting in clinical manifestations of pericarditis. In animal models of PCIS, systemic release of cardiac antigens and self-antigen specific responses has been hypothesized. In our case cardiac tamponade complicating the ablation procedure probably initiated the epicardial and pericardial inflammatory response. Even if based on few data, the patient was treated with colchicine first, avoiding aspirin because of the hemorrhagic pericardial fluid; glucocorticoids were then started when symptoms and signs of PCIS slowly resolved despite colchicine treatment. The pericardial fluid was hemorrhagic (Hb 5.9 g/dl) and treatment with apixaban, in the context of an inflammatory mesothelial response, could have caused this peculiar, hemorrhagic, pericardial reaction.

THE CLINICAL COURSE OF MYOCARDIAL INFARCTION PECULIARITIES IN MEN UNDER 60 YEARS OLD WITH RECURRENT EPISODES OF ISCHEMIA

Relevance. Recurrent myocardial infarction and early postinfarction angina negatively affects on the prognosis of myocardial infarction. Aim. To evaluate myocardial infarction clinical features in men under 60 years old with recurrent myocardial infarction and early postinfarction angina to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with recurrent myocardial infarction - 79 patients; II - control, without it - 432 patients. A comparative assessment of the myocardial infarction clinical features frequency in selected groups were performed. Results. The studied groups did not differ in the frequency of the main variants of the myocardial infarction course. In patients of the study group more often than in the control group, a complicated course of the disease was observed (88.2 and 50.2%, respectively; p &lt; 0.0001), deaths (13.6 and 3.4%; p &lt; 0.0001). Complications in the study group were dominated by arrhythmias (47.3 and 33.7%; p = 0.007), cardiogenic shock (13.6 and 6.1%; p = 0.006), myocardial ruptures (3.6 and 0.5% ; p = 0.004), thromboembolism (15.5 and 2.2%; p &lt;0.0001), urinary dysfunction (7.3 and 2.5%; p = 0.01), Dressler's syndrome (4.5 and 1.1%; p = 0.009) and mental disorders (16.4 and 5.6%; p &lt; 0.0001). Conclusions. Nonanginal forms of the disease in the study group were observed in 17% of cases. The complications of the disease for group I are characterized by cardiac arrhythmias and conduction disorders, thromboembolism, myocardial ruptures, cardiogenic shock, extracardiac complications of myocardial infarction. The study group has a worse prognosis, which requires early diagnosis, revascularization, the use of auxiliary mechanical devices, and careful implementation of standardized treatment algorithms.

Pericardial Effusion Secondary to Dressler′s Syndrome Leading to Intractable Ventricular Tachycardia

Post infarction pericarditis, Dressler's syndrome is a well-recognized condition, but its incidence has decreased in the present interventional era due to early reperfusion strategy. We encountered an unusual association of large pericardial effusion secondary to Dressler's syndrome and intractable ventricular tachycardia that reverted upon pericardiocentesis. We coined a term “electrical tamponade” to describe an electrical storm or high-grade ventricular arrhythmias secondary to pericardial effusion.

Neutrophil-to-Lymphocyte Ratio at Emergency Room Predicts Mechanical Complications of ST-segment Elevation Myocardial Infarction.

BackgroundThe neutrophil-to-lymphocyte ratio (NLR) has been proven to be a reliable inflammatory marker. A recent study reported that elevated NLR is associated with adverse cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI). We investigated whether NLR at emergency room (ER) is associated with mechanical complications of STEMI undergoing primary percutaneous coronary intervention (PCI).MethodsA total of 744 patients with STEMI who underwent successful primary PCI from 2009 to 2018 were enrolled in this study. Total and differential leukocyte counts were measured at ER. The NLR was calculated as the ratio of neutrophil count to lymphocyte count. Patients were divided into tertiles according to NLR. Mechanical complications of STEMI were defined by STEMI combined with sudden cardiac arrest, stent thrombosis, pericardial effusion, post myocardial infarction (MI) pericarditis, and post MI ventricular septal rupture, free-wall rupture, left ventricular thrombus, and acute mitral regurgitation during hospitalization.ResultsPatients in the high NLR group (> 4.90) had higher risk of mechanical complications of STEMI (P = 0.001) compared with those in the low and intermediate groups (13% vs. 13% vs. 23%). On multivariable analysis, NLR remained an independent predictor for mechanical complications of STEMI (RR = 1.947, 95% CI = 1.136–3.339, P = 0.015) along with symptom-to balloon time (P = 0.002) and left ventricular dysfunction (P < 0.001).ConclusionNLR at ER is an independent predictor of mechanical complications of STEMI undergoing primary PCI. STEMI patients with high NLR are at increased risk for complications during hospitalization, therefore, needs more intensive treatment after PCI.