Novel Pathophysiological, Diagnostic and Therapeutic Concepts in Acute and Recurrent Pericarditis

Figures

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  Fig. 1.. Animal models that investigated acute pericarditis. A limited number of animal models has been available for many years, thus explaining the limited knowledge about pericarditis pathophysiology and the availability of very few therapies. Interestingly, most of the stimuli of these animal models had a direct, yet previously unknown, link with the NLRP3 inflammasome. Indeed, hydrated magnesium silicate (talc) and Freund’s adjuvant containing aluminum are canonical stimuli for the NLRP3 inflammasome activation. An innovative murine model of acute pericarditis is based on intrapericardial injection of zymosan A that generates an inflammatory reaction of the pericardium.

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  Fig. 2.. A novel murine model of acute pericarditis induced by zymosan A. Injection of zymosan A into the pericardial sac induces a local inflammatory reaction. Following intrapericardial zymosan A injection, augmented pericardial effusion and thickness were observed in parallel with NLRP3 inflammasome activation. Reproduced with permission from “The Role of NLRP3 Inflammasome in Pericarditis: Potential for Therapeutic Approaches”, Mauro AG and Bonaventura A et al., JACC Basic Transl Sci. 2021 Feb 22; 6 (2): 137–150 [6].

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  Fig. 3.. Main findings at CMR in patients with acute pericarditis. Reproduced with permission from “Management of Acute and Recurrent Pericarditis: JACC State-of-the-Art Review”, Chiabrando JG and Bonaventura A et al., J Am Coll Cardiol. 2020 Jan 7; 75 (1): 76–92 [30].

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  Fig. 4.. Suggested flowchart for the use of IL-1 inhibitors in patients with recurrent pericarditis. In patients experiencing ≥2 recurrences, it is important to evaluate specific disease phenotypes to tailor the therapeutic strategy. For those with an auto-inflammatory phenotype, an IL-1 inhibitor should be the drug of choice compared with glucocorticoids. On the contrary, for patients presenting without a clear auto-inflammatory phenotype, low-dose glucocorticoids could be evaluated along with IL-1 inhibitors on a case-by-case basis.