Key result
Anti-inflammatory therapy completely resolves constrictive pericarditis in 48% of patients.
Early identification of active pericardial inflammation using multimodality imaging allows for targeted anti-inflammatory therapy, potentially reversing constrictive physiology and avoiding the need for pericardiectomy.
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Supports imaging to guide anti-inflammatory therapy before pericardiectomy; extends evidence for reversing constrictive physiology.
Constrictive pericarditis (CP) represents a spectrum of pericardial diseases characterized by impaired ventricular filling due to a noncompliant pericardium. Within this continuum, effusive constrictive pericarditis (ECP) and transient constrictive pericarditis are characterized by active inflammation. ECP combines pericardial effusion and constrictive physiology, whereas transient constrictive pericarditis is characterized by resolution, often after anti-inflammatory therapy. These conditions often result from idiopathic, post-surgical, autoimmune, or tuberculous causes and may progress from acute inflammation to chronic fibrosis and calcification, termed chronic constrictive pericarditis. Multimodality imaging, including echocardiography, cardiac magnetic resonance imaging, and cardiac computed tomography, plays a key role in establishing the diagnosis, assessing inflammation, and guiding treatment. In patients with active pericardial inflammation, increasing evidence and practice supports the early and combined initiation of anti-inflammatory therapy including nonsteroidal agents, colchicine, corticosteroids, and interleukin-1 inhibitors to reverse constrictive pathophysiology.
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Harake et al. (2026) conducted a review in Constrictive pericarditis and effusive constrictive pericarditis. anti-inflammatory therapy was evaluated on resolution of constrictive physiology after anti-inflammatory treatment. Anti-inflammatory therapy led to complete resolution in 48% of patients with constrictive pericarditis after treatment.
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