What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Pericarditis (n=170). Intervention: Expert diagnostic evaluation vs. Referring diagnosis. Primary outcome: Prevalence of misdiagnosed pericarditis.

November 20, 2025JACC Advances1 citationsOpen Access

Investigating Pericarditis Diagnosis in a Tertiary Pericardial Center

AHAbdel Hadi El HajjarCleveland Clinic ZZZiad ZalaquettCleveland Clinic ARAkiva RosenzveigInterventional Cardiology

Key Result

Thirty-five percent of patients referred to a tertiary pericardial center with a diagnosis of pericarditis were misdiagnosed, with COVID-19 infection and incidental pericardial effusion associated with higher misdiagnosis rates.

Study Design

Type

Cross-Sectional (n=170)

Multicenter

Structured PICO

Population

170 adult patients referred to a tertiary pericardial center with a diagnosis of pericarditis, evaluated to determine the rate and characteristics of misdiagnosis.

Outcome

Prevalence of misdiagnosed pericarditis (determined according to 2015 ESC guidelines)

A significant proportion (35%) of patients referred to a tertiary center for pericarditis are misdiagnosed, underscoring the need for strict adherence to ESC diagnostic criteria and the potential value of cardiac MRI.

Limitations

Descriptive study not powered to confirm significant differences.
Inability to identify specific healthcare providers for self-referred patients.
Lack of prospective follow-up to determine alternative diagnoses for all misdiagnosed patients.
Incomplete access to historical laboratory and EKG tracings from outside institutions.
Study focused only on patients referred with an outside diagnosis of pericarditis.

Abstract

BACKGROUND: Pericarditis diagnosis can be challenging due to its nonspecific presentation, which may lead to frequent misdiagnosis. OBJECTIVES: In this study, the authors aimed to report the rate of misdiagnosed pericarditis and describe the characteristics of these patients. METHODS: Between September 2022 and September 2023, patients referred to the Pericardial Center with a diagnosis of pericarditis were enrolled in a prospective registry. Data were collected using a standardized history and physical examination template. Diagnosis was established according to the 2015 European Society of Cardiology guidelines. The prevalence of misdiagnosed pericarditis was calculated. Demographics, comorbidities, symptoms, laboratory results, and imaging were compared between the accurately diagnosed (group 1) and misdiagnosed pericarditis cohorts (group 2). RESULTS: A total of 170 patients were included; the mean age was 49.1 years. Thirty-five percent of patients were misdiagnosed. Demographics were similar in both groups. Significant differences were found between group 1 and group 2) in coronary artery disease (17.3% vs 5.0%, P = 0.02), valvular disease (23.6% vs 8.3%, P = 0.01), and atrial fibrillation (24.5% vs 6.7%, P < 0.01). Significant late gadolinium enhancement on magnetic resonance imaging, raised inflammatory markers, electrocardiogram changes, and specific pericardial pain were more common in the accurately diagnosed group (P < 0.05). COVID-19 infection was significantly higher in the misdiagnosed group (16.7% vs 6.4%, P < 0.05), whereas cardiac surgery was significantly lower (3.3% vs 18.2%, P < 0.05). CONCLUSIONS: Thirty-five percent of patients referred to the pericardial center are misdiagnosed with pericarditis. Inflammatory markers and late gadolinium enhancement on magnetic resonance imaging can help refine the diagnosis. COVID-19 infection is associated with higher rates of misdiagnosis.

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