January 11, 2025Current Cardiology Reports13 citationsOpen Access

Old and New Biomarkers in Idiopathic Recurrent Acute Pericarditis (IRAP): Prognosis and Outcomes

Q: What is the clinical evidence from this study?

Study design: Review. Population: Idiopathic recurrent acute pericarditis (IRAP). Intervention: Biomarkers (CRP, CBC, D-Dimer, Troponins, SAA).

RMRuggiero MascoloGeneral Cardiology EBEmanuele BizziCross-Cutting Cardiology MMMartina MartelliUniversity of Milan

Key Result

Classical inflammatory biomarkers like C-reactive protein, complete blood count, D-dimer, and serum amyloid A are crucial for diagnosing and predicting outcomes in recurrent acute pericarditis.

Structured PICO

Population

Patients with idiopathic recurrent acute pericarditis (IRAP)

Intervention

Serum biomarkers including C-reactive protein (CRP), leukocytes, hemoglobin, D-dimer, cardiac troponins, antinuclear antibodies (ANA), anti-heart antibodies (AHA), and anti-intercalated disk antibodies (AIDA)

Outcome

Diagnosis, prognosis, and outcomes including short-term complications (cardiac tamponade, recurrences) and long-term complications (constrictive pericarditis, death)

Serum biomarkers, particularly CRP and white blood cell counts, are essential for diagnosing, phenotyping, and predicting outcomes in idiopathic recurrent acute pericarditis, though novel autoantibody markers require further validation.

Limitations

Most studies evaluating these biomarkers were small and observational, requiring cautious interpretation.
Many biomarkers like CRP, leukocytes, D-dimer, and ANA have low specificity.
Lack of external validation for novel markers like the INFLA-score, anti-heart, and anti-intercalated disk antibodies.
Reliable biomarkers for CRP-negative pericarditis remain an unmet clinical need.

Abstract

PURPOSE OF REVIEW: To outline the latest discoveries regarding the utility and reliability of serum biomarkers in idiopathic recurrent acute pericarditis (IRAP), considering recent findings on its pathogenesis. The study highlights the predictive role of these biomarkers in potential short- (cardiac tamponade, recurrences) and long-term complications (constrictive pericarditis, death). RECENT FINDINGS: The pathogenesis of pericarditis has been better defined in recent years, focusing on the autoinflammatory pathway. New studies have demonstrated the pivotal role of the classical inflammatory biomarkers in distinguishing pericarditis phenotypes (high-grade vs. low-grade inflammation) and in defining outcomes of this condition. Pericarditis involves intense inflammatory activity, which causes elevation of different markers, such as C-reactive protein, erythrocyte sedimentation rate, neutrophils and platelets, serum amyloid A and D-Dimer. Conversely, lymphocytes are often reduced, as well as hemoglobin during the acute phase. Cardiac troponins T and I are elevated in up to 30% of cases. A Biomarker for CRP-negative cases is needed. Other markers have been proposed for diagnosis and prognosis in IRAP, such as anti-heart antibodies and anti-intercalated disk antibodies, but we need further studies to validate them.

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