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

Dali Feng, James Glockner, Kyehun Kim, Matthew Martinez, Imran S. Syed, Philip A Araoz, Jerome Breen, Raul Emilio Espinosa, Thoralf Sundt, Hartzell V Schaff, Jae Kuen Oh

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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.

Original languageEnglish (US)
Pages (from-to)1830-1837
Number of pages8
JournalCirculation
Volume124
Issue number17
DOIs
StatePublished - Oct 25 2011

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Constrictive Pericarditis
Gadolinium
Anti-Inflammatory Agents
Magnetic Resonance Imaging
Therapeutics
Blood Sedimentation
Inflammation
C-Reactive Protein
Pericardiectomy

Keywords

  • Cardiac imaging techniques
  • Gadolinium
  • Inflammation
  • Magnetic resonance imaging
  • Pericarditis, constrictive

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

@article{bf5e94883aef4afeab6cf46cc5c805a6,
title = "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",
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.",
keywords = "Cardiac imaging techniques, Gadolinium, Inflammation, Magnetic resonance imaging, Pericarditis, constrictive",
author = "Dali Feng and James Glockner and Kyehun Kim and Matthew Martinez and Syed, {Imran S.} and Araoz, {Philip A} and Jerome Breen and Espinosa, {Raul Emilio} and Thoralf Sundt and Schaff, {Hartzell V} and Oh, {Jae Kuen}",
year = "2011",
month = "10",
day = "25",
doi = "10.1161/CIRCULATIONAHA.111.026070",
language = "English (US)",
volume = "124",
pages = "1830--1837",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "17",

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TY - JOUR

T1 - Cardiac magnetic resonance imaging pericardial late gadolinium enhancement and elevated inflammatory markers can predict the reversibility of constrictive pericarditis after antiinflammatory medical therapy

T2 - A pilot study

AU - Feng, Dali

AU - Glockner, James

AU - Kim, Kyehun

AU - Martinez, Matthew

AU - Syed, Imran S.

AU - Araoz, Philip A

AU - Breen, Jerome

AU - Espinosa, Raul Emilio

AU - Sundt, Thoralf

AU - Schaff, Hartzell V

AU - Oh, Jae Kuen

PY - 2011/10/25

Y1 - 2011/10/25

N2 - 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.

AB - 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.

KW - Cardiac imaging techniques

KW - Gadolinium

KW - Inflammation

KW - Magnetic resonance imaging

KW - Pericarditis, constrictive

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