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