ABC | Volume 114, Nº4, April 2020

Original Article Fernandes et al. Galectin-3 in pericardial constriction Arq Bras Cardiol. 2020; 114(4):683-689 Fourteen (56%) patients presented with New York Heart Association (NYHA) functional class III/IV on admission. Analyzing the clinical signs, patients with ascites had higher Gal-3 levels (16.2 ng/mL [11.6-17.5]) compared with those without ascites, (8.2 ng/mL [6.6-14.8]), with no statistically significant difference though (p = 0.06; CI 95% 0.98-1.72). No association was found of Gal-3 levels with any of the other signs described. The most frequent etiologic diagnosis was idiopathic (n = 19, 76%), tuberculosis (n = 3, 12%), followed by collagenases (n = 2, 8%), and post-surgery (n = 1, 4%). There were no deaths after pericardiectomy. Laboratory and complementary tests The median values of hemoglobin, creatinine, C-reactive protein, BNP and Gal-3 are presented in Table 1. Gal‑3 levels were not significantly higher in CCP patients compared with control patients. The median level of Gal-3 was 14.8 [9.7‑17.2] ng/mL and 11.8 [10.6-14.2] ng/mL for CCP and controls respectively (p = 0.22). In addition, no significant association was observed between Gal-3 levels and echocardiographic measures (left ventricular diastolic diameter, LVDD; left ventricular systolic diameter, LVSD, left atrial diameter, left ventricular ejection fraction), or with CMR measures (pulmonary artery systolic pressure, PASP > 55 mmHg; left atrial diameter; abnormal septal motion (septal bouncing); vena cava dilatation and myocardial and pericardial late enhancement). Imaging examinations All subjects underwent echocardiography and CMR examinations. The median ejection fraction measured by echocardiography and CMR was 60% and 57%, respectively. Analyzing the echocardiographic parameters, only 13 (52%) of the results suggested constrictive pericarditis as a diagnosis. In addition, pericardial thickening was observed in 17 (68%) subjects and inspiratory variation in mitral and tricuspid flow was observed in 13 (52%), suggesting diastolic restriction (Table 2). The CMR images suggested a CCP diagnosis in 23 (92%) subjects. Pericardial thickness (> 4 mm) was found in 21 (84%) subjects, and the most frequent abnormalities observed were septal bouncing and aortic and vena cava dilatation, both observed in 23 (92%) patients, followed by increased left atrium in 22 (88%) (Table 3). Cardiopulmonary exercise test In all subjects, the CPET proved to be safe, without serious complications. The tests were considered effective once median respiratory exchange ratio was 1.1 at both time Table 2 – Echocardiography and cardiac magnetic resonance variables Echocardiography variables N % Echo suggests CCP 13 52 Aortic sinus (mm) 30 (29-34) Left atrium Diastolic diameter (mm) 43.5 (40-47) Interventricular septum (mm) 8 (8-9) Posterior wall (mm) 8 (8-9) RVDD basal (mm) 28 (26-32) LVDD (mm) 45 (41-46) LVSD (mm) 29 (27-32) LVEF (%) 60 (59-66) Pericardial thickness (> 4 mm) 17 68 Respiratory flow variations (%) 13 52 Cardiac magnetic resonance (CMR) CMR suggests CCP 23 92 Pericardial enhancement 6 24 Miocardial enhancement 2 8 Septal bouncing 23 92 Increased Left atrium 22 88 Vena cava dilatation 23 92 LVEF (%) 57 (54-62) Pericardial thickness (mm) 6 (5-8) Pericardial thickness (> 4 mm) 21 84 Continuous variables are presented as median and interquartile range [IQR], categorical data are presented as percentage. CCP: chronic constrictive pericarditis; RVDD: right ventricular diastolic diameter; LVDD: left ventricular diastolic diameter; LVSD: left ventricular systolic diameter; LVEF: left ventricular ejection fraction. 686