Complicated Pericarditis
Key result
Early high-dose corticosteroids, lack of colchicine, and elevated hs-CRP linked to complicated pericarditis.
Why the study?
Although most patients with acute pericarditis have a benign course, a minority develop complicated pericarditis requiring focused care regarding risk factors, imaging, pathophysiology, and novel treatments.
Key Points
- This review focuses on the management and understanding of complicated pericarditis, including its risk factors and potential new treatments.
- Reviewed literature on risk factors such as corticosteroid use, colchicine absence, and C-reactive protein levels.
- Discussed the role of cardiovascular magnetic resonance imaging in assessing inflammation.
- Examined the link between inflammasome disorders and recurrent idiopathic pericarditis.
- Early high-dose corticosteroids were associated with complicated pericarditis development.
- Cardiovascular magnetic resonance imaging may assess pericardial inflammation effectively.
- Targeting the inflammasome could enhance remission and resolution of attacks.
PICO
P
Population
Complicated pericarditis
Ask about this paper
Answers are grounded in this paper and cite their sources.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The magnitude of pericardial delayed hyperenhancement informs the expected clinical course and provides insights into the appropriate duration of treatment.”
“The emergence of advanced imaging — including echo as well as CMR — as a comprehensive diagnostic and monitoring tool and the addition of IL-1 blockers to the treatment armamentarium have significantly changed our ability to manage this very difficult condition.”
Implication
May support targeted anti-inflammatory therapies in complicated pericarditis; leaves open confirmation in prospective trials.
Abstract
Most patients with acute pericarditis have a benign course and a good prognosis. However, a minority of patients develop complicated pericarditis, and the care of these patients is the focus of this review. Specifically, we address risk factors, multimodality imaging, pathophysiology, and novel treatments. The authors conclude that: 1) early high-dose corticosteroids, a lack of colchicine, and an elevated high-sensitivity C-reactive protein are associated with the development of complicated pericarditis; 2) in select cases, cardiovascular magnetic resonance imaging may aid in the assessment of pericardial inflammation and constriction; 3) given phenotypic similarities between recurrent idiopathic pericarditis and periodic fever syndromes, disorders of the inflammasome may contribute to relapsing attacks; and 4) therapies that target the inflammasome may lead to more durable remission and resolution. Finally, regarding future investigations, the authors discuss the potential of cardiovascular magnetic resonance to inform treatment duration and the need to compare steroid-sparing treatments to pericardiectomy.
Discussion
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Cite This Study
Cremer et al. (2016) conducted a review in Complicated pericarditis. Early high-dose corticosteroids, lack of colchicine, and elevated high-sensitivity C-reactive protein are associated with the development of complicated pericarditis.