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

Study Questions:

Do cardiac magnetic resonance (CMR) imaging pericardial late gadolinium enhancement (LGE) and inflammatory biomarkers predict the reversibility of constrictive pericarditis after anti-inflammatory therapy?

Methods:

A retrospective review identified 89 patients over a 7-year interval with constrictive pericarditis who also underwent CMR imaging; of these, 29 patients also received anti-inflammatory medications after CMR. A subset of 14 patients had resolution of constrictive pericarditis (defined by improvement by one New York Heart Association [NYHA] grade), whereas 15 patients had persistent disease after 13 months.

Results:

Baseline LGE pericardial thickness was greater in the group with reversible constrictive pericarditis than in the persistent group (4 ± 1 vs. 2 ± 1 mm, p = 0.001). Qualitative intensity of pericardial LGE was moderate or severe in 93% of the group with reversible disease and in 33% of the persistent disease group (p = 0.002). CMR imaging LGE pericardial thickness ≥3 mm had 86% sensitivity and 80% specificity to predict constrictive pericarditis reversibility. The group with reversible disease also had higher baseline C-reactive protein and erythrocyte sedimentation rate than the persistent disease group (59 ± 52 vs. 12 ± 14 mg/L, p = 0.04 and 49 ± 25 vs. 15 ± 16 mm/h, p = 0.04, respectively). Anti-inflammatory therapy was associated with a reduction in C-reactive protein, erythrocyte sedimentation rate, and pericardial LGE in the group with reversible constrictive pericarditis, but not in the persistent disease group.

Conclusions:

Reversible constrictive pericarditis was associated with pericardial and systemic inflammation. Anti-inflammatory therapy was associated with a reduction in pericardial and systemic inflammation and LGE pericardial thickness, with resolution of constrictive pericarditis physiology and symptoms. The authors note that further studies in a larger number of patients are needed.

Perspective:

This small, retrospective pilot study demonstrated an association between systemic inflammatory markers and CMR pericardial LGE with improvement in NYHA functional class following anti-inflammatory therapy among patients with clinical evidence of constrictive pericarditis. It makes sense that active inflammation would respond to anti-inflammatory therapy. However, this study probably did not address patients with advanced (calcific) pericardial constriction.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Pericardial Disease, Interventions and Imaging, Magnetic Resonance Imaging

Keywords: Constriction, Inflammation, Blood Sedimentation, Sensitivity and Specificity, Gadolinium, Pericarditis, New York, Magnetic Resonance Imaging, Pericardiectomy, C-Reactive Protein, Biological Markers, Magnetic Resonance Spectroscopy


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