Cardiac Magnetic Resonance Imaging Pericardial Late Gadolinium Enhancement and Elevated Inflammatory Markers Can Predict the Reversibility of Constrictive Pericarditis After Antiinflammatory Medical Therapy A Pilot Study

• Published in: Circulation (New York, N.Y.) Vol. 124; no. 17; pp. 1830 - 1837
• Main Authors: DALI FENG, GLOCKNER, James, OH, Jae K, KIM, Kyehun, MARTINEZ, Matthew, SYED, Imran S, ARAOZ, Philip, BREEN, Jerome, ESPINOSA, Raul E, SUNDT, Thoralf, SCHAFF, Hartzell V
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 25.10.2011
• Subjects: Adult; Aged; Anti-Inflammatory Agents - therapeutic use; Biological and medical sciences; Biomarkers - blood; Blood and lymphatic vessels; Blood. Blood coagulation. Reticuloendothelial system; Cardiology. Vascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Follow-Up Studies; Gadolinium; Humans; Inflammation Mediators - antagonists & inhibitors; Inflammation Mediators - blood; Inflammation Mediators - physiology; Magnetic Resonance Imaging, Cine - methods; Male; Medical sciences; Middle Aged; Pericarditis, Constrictive - blood; Pericarditis, Constrictive - diagnosis; Pericardium - pathology; Pharmacology. Drug treatments; Pilot Projects; Predictive Value of Tests; Single-Blind Method; Pericardial constriction; constrictive; magnetic resonance imaging; Antiinflammatory agent; Gadolinium; Cardiovascular disease; Inflammation; cardiac imaging techniques; Nuclear magnetic resonance imaging; Pericardium; Treatment; pericarditis; Heart disease; Pericardial disease; Reversibility
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.111.026070

Constrictive pericarditis (CP) is a disabling disease, and usually requires pericardiectomy to relieve heart failure. Reversible CP has been described, but there is no known method to predict the reversibility. Pericardial inflammation may be a marker for reversibility. As a pilot study, we assessed whether cardiac magnetic resonance imaging pericardial late gadolinium enhancement (LGE) and inflammatory biomarkers could predict the reversibility of CP after antiinflammatory therapy. Twenty-nine CP patients received antiinflammatory medications after cardiac magnetic resonance imaging. Fourteen patients had resolution of CP, whereas 15 patients had persistent CP after 13 months of follow-up. Baseline LGE pericardial thickness was greater in the group with reversible CP than in the persistent CP group (4 ± 1 versus 2 ± 1 mm, P = 0.001). Qualitative intensity of pericardial LGE was moderate or severe in 93% of the group with reversible CP and in 33% of the persistent CP group (P = 0.002). Cardiac magnetic resonance imaging LGE pericardial thickness ≥ 3 mm had 86% sensitivity and 80% specificity to predict CP reversibility. The group with reversible CP also had higher baseline C-reactive protein and erythrocyte sedimentation rate than the persistent CP group (59 ± 52 versus 12 ± 14 mg/L, P = 0.04 and 49 ± 25 versus 15 ± 16 mm/h, P = 0.04, respectively). Antiinflammatory therapy was associated with a reduction in C-reactive protein, erythrocyte sedimentation rate, and pericardial LGE in the group with reversible CP but not in the persistent CP group. Reversible CP was associated with pericardial and systemic inflammation. Antiinflammatory therapy was associated with a reduction in pericardial and systemic inflammation and LGE pericardial thickness, with resolution of CP physiology and symptoms. Further studies in a larger number of patients are needed.