Impaired baseline Global Longitudinal Strain (> -19.4%) was independently associated with a higher risk of recurrent pericarditis over 18 months compared to better GLS (59% vs 32%; HR 2.15; p=0.017).
Cohort (n=147)
No
Does impaired baseline GLS predict recurrent pericarditis in patients with acute or recurrent pericarditis who have normal hs-cTn and LVEF?
In patients with pericarditis and normal conventional markers (LVEF and hs-cTn), impaired baseline GLS identifies subclinical myocardial involvement and independently predicts a higher risk of disease recurrence.
Effect estimate: HR 2.15
Absolute Event Rate: 59% vs 32%
p-value: p=0.017
Abstract Background Pericarditis is traditionally considered confined to the pericardium when high-sensitivity troponin (hs-cTn) and left ventricular ejection fraction (LVEF) are normal. However, conventional echocardiography may overlook subtle myocardial involvement with important implications. Speckle-tracking echocardiography allows a refined evaluation of myocardial deformation via Global Longitudinal Strain (GLS). While GLS has transformed risk stratification in heart failure and cardiomyopathies, its potential role in pericardial diseases remains largely underexplored. Purpose We aimed to assess whether impaired GLS in patients with pericarditis (despite normal hs-cTn and LVEF) correlates with a greater inflammatory burden and can identify individuals at heightened risk of recurrence. Methods In this prospective cohort study, 147 patients with acute or recurrent pericarditis, diagnosed according to 2015 ESC criteria (pericarditic chest pain, friction rub, pericardial effusion, or ECG changes) were recruited from a tertiary pericarditis clinic. All patients had preserved LVEF and negative hs-cTn at baseline, and underwent left ventricular GLS assessment at presentation and at 6 months. Those with hs-cTn elevation, impaired LVEF, wall motion abnormalities, inadequate acoustic windows, or active pericarditis at 6 month visit were excluded. Echocardiographic assessments were performed using the same ultrasound system by an EACVI-certified cardiologist, with 50 scans re-analysed blinded by a second expert. Results The cohort had a mean age of 44±18 years, 60% female, 83% idiopathic aetiology and 84% presenting with recurrent pericarditis. Baseline LVEF was 59±5%. GLS improved significantly from baseline to follow-up (from -19.4±2.7% to -20.9±2.3%, p0.01, Figure 1A), suggesting reversibility of myocardial strain abnormalities with inflammation resolution. Dividing the cohort at the mean GLS value of -19.4%, those with a worse baseline GLS (-19.4%) were more likely to have elevated C-reactive protein (CRP): 32% vs 16%, p=0.034. Over an 18-month follow-up, recurrent pericarditis occurred in 44% and was more common in those with impaired baseline GLS (59% vs 32%, p=0.017, Figure 1B). In Cox regression analysis, baseline GLS -19.4% (HR=2.15), female gender (HR=2.19), baseline CRP elevation (HR=1.90), and prior corticosteroid use (HR=1.99; Table 1, Figure 2) were independently associated with recurrent pericarditis. Conclusions Our findings suggest that GLS assessment in pericarditis could provide valuable clinical insights beyond conventional markers. The association between impaired GLS and elevated CRP suggests a higher inflammatory burden and possible subclinical myocardial involvement. Moreover, patients with impaired GLS were at increased risk of recurrence, supporting the potential of GLS as a prognostic tool. This may enable earlier identification of high-risk patients and facilitate more personalised, targeted therapeutic strategies.FIGURE 1A/B TABLE 1
Andreis et al. (Sat,) conducted a cohort in Acute or recurrent pericarditis (n=147). Impaired baseline Global Longitudinal Strain (> -19.4%) vs. Baseline Global Longitudinal Strain ≤ -19.4% was evaluated on Recurrent pericarditis (HR 2.15, p=0.017). Impaired baseline Global Longitudinal Strain (> -19.4%) was independently associated with a higher risk of recurrent pericarditis over 18 months compared to better GLS (59% vs 32%; HR 2.15; p=0.017).