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Cardiac Magnetic Resonance Imaging Pericardial Late Gadolinium Enhancement and Elevated Inflammatory Markers Can Predict the Reversibility of Constrictive Pericarditis After Antiinflammatory Medical Therapy
Circulation
  • DaLi Feng, MD, Metropolitan Heart and Vascular Institute
  • James Glockner, MD, Mayo Clinic - Minnesota
  • Kyehun Kim, MD, Mayo Clinic - Minnesota
  • Matthew W Martinez, Lehigh Valley Health Network
  • Irman S Syed, MD, Mayo Clinic - Minnesota
  • Philip Araoz, MD, Mayo Clinic - Minnesota
  • Jerome Breen, MD, Mayo Clinic - Minnesota
  • Raul E Espinosa, MD, Mayo Clinic - Minnesota
  • Thoralf Sundt, MD, Mayo Clinic - Minnesota
  • Hartzell V Schaff, MD, Mayo Clinic - Minnesota
  • Jae K Oh, MD, Mayo Clinic - Minnesota
Publication/Presentation Date
10-25-2011
Abstract

BACKGROUND: 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.

METHOD AND RESULTS: 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.

CONCLUSIONS: 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.

PubMedID
21969014
Document Type
Article
Citation Information

Feng D., Glockner J., Kim K., Martinez M., Syed IS., Araoz P., Breen J., Espinosa RE., Sundt T., Schaff HV., & Oh JK. (2011). 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. Circulation,124(17), 1830-1837. doi:10.1161/CIRCULATIONAHA.111.026070.