Good Prognosis for Pericarditis With and Without Myocardial Involvement: Results From a Multicenter, Prospective Cohort Study

Study Questions:

What is the prognosis of myopericarditis/perimyocarditis?

Methods:

In a multicenter, prospective cohort, 486 patients (median age 39 years, range 18-83 years, 300 men) with acute pericarditis or a myopericardial inflammatory syndrome (myopericarditis/perimyocarditis; 85% idiopathic, 11% connective tissue disease or inflammatory bowel disease, 5% infective) were prospectively evaluated, from January 2007 to December 2011. The diagnosis of acute pericarditis was based on the presence of two of four clinical criteria (chest pain, pericardial rubs, widespread ST-segment elevation or PR depression, and new or worsening pericardial effusion). Myopericardial inflammatory involvement was suspected with atypical electrocardiogram changes for pericarditis, arrhythmias, and cardiac troponin elevation, or new or worsening ventricular dysfunction on echocardiography and confirmed by cardiac magnetic resonance.

Results:

After a median follow-up of 36 months, normalization of left ventricular function was achieved in >90% of patients with myopericarditis/perimyocarditis. No deaths were recorded, and there was no evolution to heart failure or symptomatic left ventricular dysfunction. Recurrences (mainly as recurrent pericarditis) were the most common complication during follow-up, and were recorded more frequently in patients with acute pericarditis (32%) than in those with myopericarditis (11%) or perimyocarditis (12%, p < 0.001). Troponin elevation was not associated with an increase in complications.

Conclusions:

The outcome of myopericardial inflammatory syndromes is good. Unlike acute coronary syndromes, troponin elevation in this setting is not a negative prognostic marker.

Perspective:

Myocardial involvement should be suspected in a patient with chest pain, ST-segment elevation, and cardiac arrhythmia. The presentation of patients with myopericarditis/perimyocarditis can be similar to those of acute coronary syndromes. However, despite myocardial involvement, this study suggests that the outcome of myopericarditis/perimyocarditis is good, and that detection of elevated troponin does not portend a worse prognosis.

Clinical Topics: Noninvasive Imaging, Pericardial Disease, Echocardiography/Ultrasound

Keywords: Prognosis, Biological Markers, Pericarditis, Troponin, Echocardiography


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