Delayed Hyperenhancement and Outcomes in Recurrent Pericarditis

Study Questions:

What is the prognostic value of quantitative assessment of pericardial delayed hyperenhancement (DHE) among patients with recurrent pericarditis?


The investigators conducted a retrospective cohort study of 159 patients with recurrent pericarditis who underwent DHE imaging and had a follow-up period of >6 months. Pericardial inflammation was quantified on short-axis DHE sequences by contouring the pericardium, selecting normal septal myocardium as a reference region, and then quantifying the pericardial signal that was >6 standard deviations above the reference. The primary outcome was clinical remission; secondary outcomes were time to recurrence and recurrence rate. Cox proportional hazards model analysis was used to determine the parameters associated with time to clinical remission, and multivariable hazard ratios (HRs) were calculated.


The mean age of the patients was 46 ± 14 years, and 52% were women. During a median follow-up period of 23 months (interquartile range, 15-34 months), 32 (20%) patients achieved clinical remission. In the multivariable Cox proportional hazards model, lower quantitative pericardial DHE (HR, 0.77; 95% confidence interval, 0.64-0.93; p = 0.008) was independently associated with clinical remission. When added to background clinical and laboratory variables, quantitative pericardial DHE had incremental prognostic value over baseline clinical and laboratory variables (integrated discrimination improvement, 8%; net reclassification improvement, 36%). Furthermore, patients with a higher quantitative DHE had shorter time to subsequent recurrence (p = 0.012) and had a higher recurrence rate at 6 months (p = 0.026).


The authors concluded that quantitative assessment of pericardial DHE was associated with clinical outcomes among patients with recurrent pericarditis.


This study reports that lower pericardial quantitative DHE was associated with clinical remission among patients with recurrent pericarditis who presented after multiple recurrences. Furthermore, when compared with other clinical variables, quantitative pericardial DHE provided better discrimination for clinical remission, and higher pericardial quantitative DHE was associated with a shorter time to recurrence and a higher recurrence rate. Intense pericardial DHE seems to indicate a more prominent chronic inflammatory process and should be the focus of future studies investigating more intensive and novel therapies including new biological and disease-modifying agents.

Clinical Topics: Noninvasive Imaging, Pericardial Disease, Magnetic Resonance Imaging

Keywords: Diagnostic Imaging, Inflammation, Magnetic Resonance Imaging, Myocardium, Pericarditis, Pericardium, Recurrence, Treatment Outcome

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