scholarly journals Prognostic role of cardiac MRI in the evaluation of patients with pericarditis: a long-term follow-up study

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
E Conte ◽  
G Lauri ◽  
C Agalbato ◽  
A Dalla Cia ◽  
S Mushtaq ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Transthoracic Echocardiography ◽  
Cardiac Mri ◽  
Systemic Autoimmune Disease ◽  
Recurrent Pericarditis ◽  
Acute Pericarditis ◽  
Pericardial Disease ◽  
Funding Sources

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Recurrent pericarditis complicates 30% of acute pericarditis cases. Aim of the present study is to evaluate the role of cardiac MRI in the identification of patients subgroup at higher risk of recurrent pericarditis. Material and methods From a registry of consecutive patients who underwent cardiac MRI from January 2014 to January 2019 we retrospectively selected a subgroup of patients with clinical diagnosis of pericarditis according ESC guidelines on pericardial disease, for which a recent (less the 2 months before cardiac MRI) transthoracic echocardiography was available. CMR protocol included bSSFP images, T2w images and LGE in all patients. Transthoracic echocardiography was considered to be positive for pericardial disease if pericardial effusion and/or sign of pericardial constriction were present; cardiac MRI was considered to be positive for pericardial disease if pericardial effusion and pericardial hyperintensity signal were detected on T2w or LGE images. Clinical follow-up was recorded for a composite end-point including new episodes of recurrent pericarditis and subsequent diagnosis of chronic constrictive pericarditis Results A total of 25 patients were included in this preliminary analysis of the study. Pericarditis etiology was unknow (idiopathic) in 17 (68%), related to systemic autoimmune disease in 5 patients (20%) and related to cancer in 3 patients (12%). In 6 patients (24%) a myopericarditis was diagnosed. According to predefined criteria 10 patients had echocardiography positive for pericardial disease (40%), while in 9 patients cardiac MRI was positive for pericardial inflammation (36%). Both echocardiography and cardiac MRI were positive in 5 patients (20%). At a mean follow-up of 35.4 ± 12.2 months a total of 9 recurrent pericarditis events were recorded. At multivariate analysis MRI positive for pericardial inflammation [HR (95%CI) 15.9 (2.7-95.5)] but not echocardiography positive for pericardial disease [HR (95%CI) 0.33 (0.1-1.5)] resulted to be associated to recurrent pericarditis at follow-up. Conclusion Cardiac MRI positive for pericardial inflammation could identify patients that may merit more aggressive anti-inflammatory therapy to prevent recurrent pericarditis.

Diseases of the Pericardium, Cardiac Tumors, and Cardiac Trauma

2016 ◽  
Author(s):  
Terrence D. Welch ◽  
Kyle W Klarich ◽  
Jae K. Oh
Keyword(s):  
Pericardial Effusion ◽  
Constrictive Pericarditis ◽  
Restrictive Cardiomyopathy ◽  
Left Ventricular ◽  
Cardiac Tumors ◽  
Management Options ◽  
Acute Pericarditis ◽  
Pericardial Disease ◽  
Cardiac Trauma ◽  
Pulsed Wave Doppler

The pericardium consists of a fibrous sac and a serous membrane. Because of its simple structure, the clinical syndromes involving the pericardium are relatively few but vary substantially in severity. Cardiac tumors may be either primary or secondary and either benign or malignant, with attachment sites throughout the endocardium. Cardiovascular trauma should be suspected in all patients with chest injuries or severe generalized trauma. Cardiovascular injury may be either blunt or penetrating. This review covers pericardial disease, cardiac tumors, and cardiovascular trauma. Figures show an electrocardiogram in acute pericarditis; acute pericarditis with delayed gadolinium enhancement of the pericardium shown with cardiac magnetic resonance imaging; underlying cause of pericardial effusion requiring pericardiocentesis; pericardial pressure-volume curves; large pericardial effusion with swinging motion of the heart resulting in electrical alternans; typical pulsed-wave Doppler pattern of tamponade; underlying causes of constrictive pericarditis in patients undergoing pericardiectomy; pericardial calcification seen on a chest radiograph; thickened pericardium; typical pulsed-wave Doppler pattern of constrictive pericarditis; typical mitral annular tissue velocities in constrictive pericarditis; a diagnostic algorithm for the echocardiographic diagnosis of constrictive pericarditis; simultaneous right ventricular and left ventricular pressure tracings in restrictive cardiomyopathy; computed tomographic scan showing inflammatory constrictive pericarditis; systolic and diastolic transesophageal echocardiographic images of a large left atrial myxoma attached to the atrial septum; a decision tree of management options for patients with suspected papillary; transesophageal echocardiographic examples of aortic valve, mitral valve, left ventricular outflow tract, and tricuspid valve papillary fibroelastomas; and transesophageal short-axis view of the descending thoracic aorta in a hypotensive patient after a motor vehicle accident. The table lists tamponade versus constriction versus restrictive cardiomyopathy. This review contains 18 highly rendered figures, 1 table, and 77 references.

The pericardium and pericardial disease

2018 ◽  
Author(s):  
David Sidebotham ◽  
Alan Merry ◽  
Malcolm Legget ◽  
Gavin Wright
Keyword(s):  
Pericardial Effusion ◽  
Constrictive Pericarditis ◽  
Restrictive Cardiomyopathy ◽  
Transoesophageal Echocardiography ◽  
Pericardial Tamponade ◽  
Acute Pericarditis ◽  
Pericardial Disease ◽  
Mechanically Ventilated ◽  
Spectral Doppler ◽  
Echocardiographic Assessment

Chapter 16 is a new chapter from earlier editions of Practical Perioperative Transoesophageal Echocardiography. It provides a short summary on the echocardiographic assessment of the normal pericardium and on pericardial disease. The characteristic TOE features of pericardial pathology (cysts, acute pericarditis, pericardial effusion, pericardial tamponade, and constrictive pericarditis) are reviewed. In particular, pericardial constriction is discussed in detail, including outlining the features that distinguish pericardial constriction from restrictive cardiomyopathy. Wherever possible, the spectral Doppler abnormalities associated with pericardial constriction and pericardial tamponade are discussed with reference to patients who are mechanically ventilated.

Pericardial diseases

2012 ◽  
Keyword(s):  
Pericardial Effusion ◽  
Constrictive Pericarditis ◽  
Acute Pericarditis ◽  
Pericardial Disease ◽  
Tuberculous Pericarditis ◽  
Pericardial Diseases ◽  
Effusive Constrictive Pericarditis

Aetiology 460Syndromes of pericardial disease 461Acute pericarditis without effusion 461Pericardial effusion with or without tamponade 462Constrictive pericarditis 464Effusive-constrictive pericarditis 465Calcific pericarditis without constriction 465Viral pericarditis 466Tuberculous pericarditis 468Uraemic pericarditis 469Neoplastic pericardial disease 470Myxoedematous effusion ...

Acute and recurrent pericarditis

ESC CardioMed ◽  
2018 ◽  
pp. 1563-1572
Author(s):  
Massimo Imazio ◽  
Fiorenzo Gaita ◽  
Yehuda Adler
Keyword(s):  
Oral Anticoagulant Therapy ◽  
Developed Countries ◽  
Acute Onset ◽  
Recurrent Pericarditis ◽  
Acute Pericarditis ◽  
Clear Cut ◽  
Large Pericardial Effusion ◽  
Anti Inflammatory ◽  
Low Prevalence

Viral and idiopathic pericarditis are the most common forms of pericarditis encountered in clinical practice in developed countries with a low prevalence of tuberculosis. The course of these cases is relatively benign and self-limiting, the most common complication being recurrence. The mainstay of therapy is empiric anti-inflammatory therapy with aspirin or a non-steroidal anti-inflammatory drug (NSAID) plus colchicine. Specific features at presentation may suggest the increased risk of complications during follow-up and non-viral aetiologies (e.g. high fever >38ºC (100.4ºF), subacute course with symptoms over several days without a clear-cut acute onset, evidence of large pericardial effusion with diastolic echo-free space >20 mm, cardiac tamponade, failure to respond within 7 days to aspirin/NSAID, associated myocarditis (myopericarditis), immunodepression, trauma, and oral anticoagulant therapy). The presence of one or more of these features identifies a potentially high-risk case of pericarditis to be admitted. In these cases an aetiology search is mandatory. Patients with pericarditis and no risk features can be considered at low risk and managed as outpatients. In these cases follow-up is mandatory after 1 week to assess the response to empiric anti-inflammatory therapy. Recurrent pericarditis is the most troublesome complication following acute pericarditis and occurs in 20–50% of patients. Most cases of recurrent pericarditis are idiopathic and the pathogenesis is presumed to be immune mediated or autoinflammatory. The prognosis of idiopathic recurrent pericarditis is generally good with the risk of chronic evolution towards constrictive pericarditis related to the aetiology and not the number of recurrences.

Overview of pericardial syndromes

ESC CardioMed ◽  
2018 ◽  
pp. 1561-1563
Author(s):  
Michael Arad ◽  
Yehuda Adler
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Pericardial Effusion ◽  
Acute Pericarditis ◽  
Pericardial Disease ◽  
Pericardial Diseases ◽  
Pericardial Syndromes ◽  
Work Up ◽  
Systemic Condition ◽  
Symptoms And Signs

Pericardial diseases manifest as a part of a systemic condition or in isolation. The clinical presentation is driven by inflammation (i.e. pericarditis), excess fluid accumulation (pericardial effusion), or pericardial stiffening (constriction). Corresponding symptoms and signs may include pain, stigmata of systemic inflammation, atrial arrhythmia, haemodynamic compromise, or chronic heart failure. Pericardial tumours and space-occupying lesions are uncommon and may be incidentally detected or present as one of the above-mentioned forms of pericardial disease. Aetiological work-up is usually unnecessary in acute pericarditis but is indicated in the incessant/chronic form and to exclude bacterial infection. Pericardial effusions need to be investigated when large and promptly evacuated when associated with haemodynamic compromise. The hallmark of constrictive physiology is ventricular interdependence. It is important to distinguish transient constriction and to treat inflammation according to aetiology prior to making a decision on surgical relief by pericardiectomy.

scholarly journals Early introduction of anakinra improves acute pericarditis and prevents tamponade in Staphylococcal sepsis

2021 ◽  
Author(s):  
Ludovico Luca Sicignano ◽  
Maria Grazia Massaro ◽  
Marinica Savino ◽  
Donato Rigante ◽  
Laura Gerardino ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Response ◽  
Early Treatment ◽  
Pathogenic Role ◽  
Acute Pericarditis ◽  
Pericardial Disease ◽  
Early Introduction ◽  
Bacterial Origin

AbstractThe clinical response to anakinra observed by this patient concurrently treated with antibiotics indirectly confirms the potentially pathogenic role of IL-1 in maintaining the pericardial disease and shows how IL-1 blockade might allow avoiding the pericardiocentesis procedure. The report supports the hypothesis that anakinra is an effective and safe tool in the early treatment of acute pericarditis of presumed bacterial origin nonresponding to targeted antibiotic therapy.

Recurrent Pericarditis in a Pediatric Patient

2011 ◽  
Vol 11 (1) ◽  
pp. 175-177
Author(s):  
Elina Ligere ◽  
Marija Leznina ◽  
Aris Lacis ◽  
Inta Bergmane ◽  
Valts Ozolins ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Pediatric Patient ◽  
Connective Tissue Disorders ◽  
Recurrent Pericarditis ◽  
Acute Pericarditis ◽  
Number Of Children ◽  
Bacterial Pericarditis ◽  
Prior Surgery ◽  
The Common ◽  
Disease Present

Recurrent Pericarditis in a Pediatric PatientRecurrent pericarditis is a chronic condition with the recurrence of pericardial effusion within 3 months after the documented acute pericarditis. The knowledge about this disease is based on observations in adults (6). The common identifiable causes of pericardial effusion in children are a prior cardiac surgery, bacterial pericarditis, malignancy or connective tissue disorders. In a significant number of children, however, despite extensive investigation, it is not possible to identify a clear aetiology. A viral cause is often suspected, though rarely confirmed. There are only few reports on the clinical course of idiopathic pericardial effusions in children. We demonstrate a case of recurrent idiopathic pericarditis with 3 episodes of recurrence within a period of 6 months with no autoimmune disease present, not related to prior surgery or malignancy.

scholarly journals Management of Lung Cancer-Associated Malignant Pericardial Effusion with Intrapericardial Administration of Carboplatin: A Retrospective Study

2021 ◽  
Vol 29 (1) ◽  
pp. 163-172
Author(s):  
Hisao Imai ◽  
Kyoichi Kaira ◽  
Ken Masubuchi ◽  
Koichi Minato
Keyword(s):  
Lung Cancer ◽  
Retrospective Study ◽  
Pericardial Effusion ◽  
Response To Treatment ◽  
Cancer Center ◽  
Acute Pericarditis ◽  
Malignant Pericardial Effusion ◽  
Threatening Condition ◽  
Life Threatening

It has been reported that 5.1–7.0% of acute pericarditis are carcinomatous pericarditis. Malignant pericardial effusion (MPE) can progress to cardiac tamponade, which is a life-threatening condition. The effectiveness and feasibility of intrapericardial instillation of carboplatin (CBDCA; 150 mg/body) have never been evaluated in patients with lung cancer, which is the most common cause of MPE. Therefore, we evaluated the effectiveness and feasibility of intrapericardial administration of CBDCA following catheter drainage in patients with lung cancer-associated MPE. In this retrospective study, 21 patients with symptomatic lung cancer-associated MPE, who were administered intrapericardial CBDCA (150 mg/body) at Gunma Prefectural Cancer Center between January 2005 and March 2018, were included. The patients’ characteristics, response to treatment, and toxicity incidence were evaluated. Thirty days after the intrapericardial administration of CBDCA, MPE was controlled in 66.7% of the cases. The median survival period from the day of administration until death or last follow-up was 71 days (range: 10–2435 days). Grade 1–2 pain, nausea, fever, and neutropenia were noted after intrapericardial CBDCA administration. No treatment-related deaths were noted in the current study. Intrapericardial administration of CBDCA (150 mg/body) did not cause serious toxicity, and patients exhibited promising responses to lung cancer-associated MPE. Prospective studies using larger sample sizes are needed to explore the efficacy and safety of this treatment for managing lung cancer-associated MPE.

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