1
|
Kumar S, Khubber S, Reyaldeen R, Agrawal A, Cremer PC, Imazio M, Kwon DH, Klein AL. Advances in Imaging and Targeted Therapies for Recurrent Pericarditis: A Review. JAMA Cardiol 2022; 7:975-985. [PMID: 35976625 DOI: 10.1001/jamacardio.2022.2584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Pericarditis is the most common form of pericardial disease. Recurrence of pericarditis affects 15% to 30% of patients after the initial episode of pericarditis. Up to 50% of patients with the first recurrence have additional recurrences. These patients often progress to have colchicine-resistant and corticosteroid-dependent disease. Rapidly evolving cardiac magnetic resonance imaging techniques and novel targeted therapies have paved the way for imaging-guided therapy for recurrent pericarditis. However, the optimal application of these recent advances remains unclear. Observations A search was conducted using the PubMed and Cochrane databases for English-language studies, management guidelines, meta-analyses, and review articles published until April 2022 on recurrent pericarditis. Following the 2015 European Society of Cardiology guidelines for the diagnosis and management of pericardial diseases, new clinical trials and registry data have emerged that demonstrate the efficacy of interleukin-1 blockers in recurrent pericarditis. In addition, new observational data have come to light supporting the use of cardiac magnetic resonance imaging in the diagnosis, risk stratification, and management of such patients. Conclusions and Relevance Advances in imaging and targeted therapies have led to a paradigm shift in the management of recurrent pericarditis. This narrative review summarizes the established and emerging data on the diagnosis and treatment of recurrent pericarditis with special emphasis on the role of cardiac magnetic resonance imaging and interleukin-1 blockers in the current era of tailored therapy for recurrent pericarditis.
Collapse
Affiliation(s)
- Sachin Kumar
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shameer Khubber
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Reza Reyaldeen
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ankit Agrawal
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul C Cremer
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Deborah H Kwon
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
2
|
Chetrit M, Xu B, Kwon DH, Ramchand J, Rodriguez RE, Tan CD, Jellis CL, Johnston DR, Renapurkar RD, Cremer PC, Klein AL. Imaging-Guided Therapies for Pericardial Diseases. JACC Cardiovasc Imaging 2020; 13:1422-1437. [DOI: 10.1016/j.jcmg.2019.08.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/01/2019] [Accepted: 08/07/2019] [Indexed: 12/11/2022]
|
3
|
Chetrit M, Natalie Szpakowski N, Desai MY. Multimodality imaging for the diagnosis and treatment of constrictive pericarditis. Expert Rev Cardiovasc Ther 2019; 17:663-672. [DOI: 10.1080/14779072.2019.1657832] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Michael Chetrit
- Department of Cardiovascular Medicine, Cleveland Clinic, Heart and Vascular Institute, Cleveland, OH, USA
| | - Natalie Natalie Szpakowski
- Department of Cardiovascular Medicine, Cleveland Clinic, Heart and Vascular Institute, Cleveland, OH, USA
| | - Milind Y. Desai
- Department of Cardiovascular Medicine, Cleveland Clinic, Heart and Vascular Institute, Cleveland, OH, USA
| |
Collapse
|
4
|
Llubani R, Böhm M, Imazio M, Fries P, Khreish F, Kindermann I. The first post-cardiac injury syndrome reported following transcatheter aortic valve implantation: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2018; 2:yty107. [PMID: 31020183 PMCID: PMC6426006 DOI: 10.1093/ehjcr/yty107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 09/05/2018] [Indexed: 11/15/2022]
Abstract
Background Post-cardiac injury syndrome is a form of secondary pericarditis with or without pericardial effusion, which typically occurs weeks to months following an injury to the heart or pericardium. Disease activity can be followed with serial testing of inflammatory markers e.g. C-reactive protein (CRP) and/or sedimentation rate, electrocardiogram, and echocardiography. Case summary A 79-year-old woman was admitted with chest pain, dyspnoea at rest, cough, and low degree fever. The patient had undergone transcatheter aortic valve implantation (TAVI) 6 months before admission. Inflammatory markers were increased and a chest X-ray and computed tomography (CT) showed a minimal left pleural effusion. An empirical antibiotic treatment and ibuprofen to control chest pain were started on the presumption of an acute bronchitis. Despite 15 days of different antibiotic protocols the markers of inflammation remained increased. A positron emission tomography with computed tomography and cardiac magnetic resonance imaging showed signs of an aseptic pericarditis. After having excluded any infectious, metabolic, drug-induced or neoplastic genesis we considered the diagnosis of late onset autoimmune-mediated pericarditis. Subsequently, treatment was promptly initiated with colchicine and prednisone. The patient reported clinical improvement in the following days and the CRP value continuously decreased. Discussion To the best of our knowledge, this is the first reported case of post-cardiac injury syndrome after TAVI. It should be considered in those patients who have persistent chest pain, fever, fatigue, and elevated inflammatory markers after a TAVI procedure, even though it may occur weeks or months after the intervention. A triple therapy with colchicine, ibuprofen, and low-dosage steroids may be used for persistent symptoms.
Collapse
Affiliation(s)
- Redi Llubani
- Department for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - Michael Böhm
- Department for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - Massimo Imazio
- Department of Medical Sciences, University Cardiology, AOU Città della Salute e della Scienza di Torino and University of Torino, Torino, Italy
| | - Peter Fries
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany
| | - Fadi Khreish
- Clinic for Nuclear Medicine, Saarland University Medical Center, Homburg, Germany
| | - Ingrid Kindermann
- Department for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| |
Collapse
|
5
|
|
6
|
Alraies MC, AlJaroudi W, Yarmohammadi H, Yingchoncharoen T, Schuster A, Senapati A, Tariq M, Kwon D, Griffin BP, Klein AL. Usefulness of cardiac magnetic resonance-guided management in patients with recurrent pericarditis. Am J Cardiol 2015; 115:542-7. [PMID: 25547939 DOI: 10.1016/j.amjcard.2014.11.041] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/17/2014] [Accepted: 11/17/2014] [Indexed: 11/16/2022]
Abstract
Recurrent pericarditis (RP) affects 10% to 50% of patients with acute pericarditis. The use of steroids has been associated with increased recurrence rate of pericarditis, along with known major side effects. Cardiac magnetic resonance imaging (CMR) is more frequently used to assess pericardial inflammation and less commonly to guide therapy. The aim of this study was to assess the utility of CMR in the management of RP compared with standard therapy. A total of 507 consecutive patients with RP after the first attack, all of whom were treated with colchicine and nonsteroidal anti-inflammatory drugs as first-line therapy, were retrospectively evaluated. There were 257 patients who were treated with medications and received CMR-guided therapy (group 1) and 250 patients who were treated with medications without CMR (group 2). The 2 groups had similar baseline characteristics and follow-up periods (17 ± 7.9 vs 16.3 ± 16.2 months, respectively, p = 0.97). CMR was used to assess the presence of pericardial inflammation, and on the basis of the results, the clinician made changes to the steroid dose dictated by the severity of inflammation. There was no significant difference in the incidence of constrictive pericarditis, pericardial window, or pericardiectomy between groups during the follow-up. However, group 2 patients had a larger number of steroid pulse therapies (defined as prednisone 50 mg/day orally for 10 days and tapering to none over 4 weeks), and higher overall total milligrams of steroid administered compared with the CMR group (p = 0.003 and p = 0.001, respectively). Recurrence and pericardiocentesis rates were lower in group 1 (p <0.0001). In conclusion, CMR-guided therapy modulates the management of RP. This approach decreased pericarditis recurrence and exposure to steroids.
Collapse
Affiliation(s)
- M Chadi Alraies
- Heart & Vascular Institute, Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio.
| | - Wael AlJaroudi
- Division of Cardiovascular Medicine, American University of Beirut, Beirut, Lebanon
| | - Hirad Yarmohammadi
- Heart & Vascular Institute, Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Teerapat Yingchoncharoen
- Heart & Vascular Institute, Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Andres Schuster
- Heart & Vascular Institute, Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Alpana Senapati
- Heart & Vascular Institute, Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Muhammad Tariq
- Heart & Vascular Institute, Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Deborah Kwon
- Heart & Vascular Institute, Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Brian P Griffin
- Heart & Vascular Institute, Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Allan L Klein
- Heart & Vascular Institute, Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
7
|
McRee CW, Mergo P, Parikh P, Pollak A, Shapiro BP. Modern advances in cardiovascular imaging: cardiac computed tomography and cardiovascular MRI in pericardial disease. Future Cardiol 2014; 10:769-79. [DOI: 10.2217/fca.14.61] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
ABSTRACT The pericardium is characterized by a two-layer sac that surrounds the heart and provides an enclosed, lubricated space. Diseases of the pericardium may occur due to active inflammation, scar, calcification or effusion. While clinical, ECG and hemodynamic evaluation have been the established methods for the diagnosis of pericardial disease, advances in cardiac computed tomography and cardiovascular MRI provide complementary tools for diagnostic, prognostic and therapeutic assessment.
Collapse
Affiliation(s)
- Chad W McRee
- Department of Cardiology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Patricia Mergo
- Department of Cardiology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Pragnesh Parikh
- Department of Cardiology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Amy Pollak
- Department of Cardiology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Brian P Shapiro
- Department of Cardiology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| |
Collapse
|