ABC | Volume 114, Nº4, April 2020

Original Article Fernandes et al. Galectin-3 in pericardial constriction Arq Bras Cardiol. 2020; 114(4):683-689 Table 1 – Clinical and laboratory measures Characteristic Measure Male sex, n (%) 19 (76) Age years, median (IQR) 45 (33-57) BMI, kg/m 2 , median (IQR) 25.6 (22-27) Time of symptoms, months median (IQR) 24 (12-36) Time of hospitalization, median (IQR) 8 (7-16) Time of ICU after procedure, median (IQR) 2 (2-3) Comorbidities, n (%) Hypertension 4 (16) Type 2 diabetes 2 (8) Chronic arterial disease 3 (12) Tabagism 5 (20) Atrial fibrillation 10 (40) Low voltage ECG 6 (24) Calcification X-ray 11 (44) Pleural effusion X-ray 5 (20) NYHA functional class, n (%) I 4 (16) II 7 (28) III 11 (44) IV 3 (12) Clinical signs, n (%) Jugular stasis 22 (88) Edema 22 (88) Ascites 18 (72) Hepatomegaly 16 (64) Pericardial knock 12 (48) Kussmaul sign 6 (24) Paradoxal pulse 5 (20) Laboratory measurements – median (IQR) Galectin-3, ng/mL* 14.8 [9.7-17.2] Hemoglobin, g/dL, 13.4 [12.8-14.3] Creatinine, mg/dL, 1.02 [0.99-1.26] CRP, mg/dL (range) 5.4 [3.2-9.4] BNP, pg/mL (range) 143 [89-209] Continuous variables are presented as median and interquartile range [IQR]. Categorical data are presented as percentage. *risk of postoperative death calculated by EuroSCORE (%). BMI: body mass index; ECG: electrocardiogram; ICU: intensive care unit; NYHA: New York Heart Association; BNP: B-type natriuretic peptide; CRP: C-reactive protein. Echocardiography The echocardiographic study was performed on a Sequoia 512 ultrasound device ( Acuson, Mountain View, California, USA ) with a 2.5 MHz transducer. All measurements were performed according to the American Society of Echocardiography Guidelines. 7 A nasal respirometer was used for simultaneous recording of respiration, which was performed by an observer blinded to the other assessments of the protocol. Two-dimensional imaging was performed from parasternal, apical, and subcostal windows. The parasternal, apical views and M-mode recordings were used to detect the presence of respiratory ventricular septal motion. Apical views were also used to detect distortion of ventricular contours caused by constrictive pericardium. The subcostal view was used to identify diameters of the inferior vena cava. Doppler information was obtained from apical, subcostal, right supraclavicular, and parasternal imaging windows. From the apical window, pulsed‑wave Doppler recordings at the level of the mitral leaflet tips were used to measure early (E) and atrial (A) diastolic velocities, deceleration time of the E wave, and respiratory variation in the E velocity. Tissue Doppler assessment of mitral annular motion was used to record and compare diastolic early (E) velocities at both the septal and lateral mitral annulus. Statistical analysis Descriptive analysis was performed; for quantitative data, central tendency and dispersion measurements are reported as median and interquartile ranges. Qualitative datawas reported as frequencies and percentages. Gal-3 levels were compared between controls and case groups usingWilcoxon rank-sum test, and the chi-square test or Fisher's exact test was used for categorical data. Spearman correlation coefficient was used to analyze the association between Gal-3 levels, parameters of echocardiography, CMR and ergometric test. An alpha error < 5%was considered statistically significant, with a confidence interval of 95%. Graphics and statistical analyses were performed with Microsoft Excel 2013 and Stata ( version 13.0, Stata Corp., College Station, TX ), with a 2-tailed p < 0.05 considered to be significant. Ethical issues The institutional review board approved this study that is in compliance with the Declaration of Helsinki. The local ethics committee approved the protocol, and all participants signed a written informed consent. Results Baseline characteristics Twenty-five patients with constrictive pericarditis underwent pericardiectomy. Median age was 45 years (33-57) with a predominance of men (n = 19, 76%), and median body mass index (BMI) was 25.6 kg/m 2 . Comorbidities were hypertension, tobacco use, type 2 diabetes, and chronic arterial disease. All baseline characteristics are listed in Table 1. In the control group, median age was 44 (33-53) years, and 19 were men. Regarding clinical characteristics, the median length of symptoms before admission was 24 (12-36) months. Median length of hospital and intensive care unit (ICU) stay was eight and two days, respectively. The main clinical signs in the patients were related to right heart failure – jugular vein distention (n = 22, 88%), edema (n = 22, 88%), ascites (n = 18, 72%) – and 16 (64%) had hepatomegaly (n = 16, 64%) at physical examination (Table 1). 685