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Thorolfsdottir RB, Jonsdottir AB, Sveinbjornsson G, Aegisdottir HM, Oddsson A, Stefansson OA, Halldorsson GH, Saevarsdottir S, Thorleifsson G, Stefansdottir L, Pedersen OB, Sørensen E, Ghouse J, Raja AA, Zheng C, Silajdzija E, Rand SA, Erikstrup C, Ullum H, Mikkelsen C, Banasik K, Brunak S, Ivarsdottir EV, Sigurdsson A, Beyter D, Sturluson A, Einarsson H, Tragante V, Helgason H, Lund SH, Halldorsson BV, Sigurpalsdottir BD, Olafsson I, Arnar DO, Thorgeirsson G, Knowlton KU, Nadauld LD, Gretarsdottir S, Helgadottir A, Ostrowski SR, Gudbjartssson DF, Jonsdottir I, Bundgaard H, Holm H, Sulem P, Stefansson K. Variants at the Interleukin 1 Gene Locus and Pericarditis. JAMA Cardiol 2024; 9:165-172. [PMID: 38150231 PMCID: PMC10753444 DOI: 10.1001/jamacardio.2023.4820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/14/2023] [Indexed: 12/28/2023]
Abstract
Importance Recurrent pericarditis is a treatment challenge and often a debilitating condition. Drugs inhibiting interleukin 1 cytokines are a promising new treatment option, but their use is based on scarce biological evidence and clinical trials of modest sizes, and the contributions of innate and adaptive immune processes to the pathophysiology are incompletely understood. Objective To use human genomics, transcriptomics, and proteomics to shed light on the pathogenesis of pericarditis. Design, Setting, and Participants This was a meta-analysis of genome-wide association studies of pericarditis from 5 countries. Associations were examined between the pericarditis-associated variants and pericarditis subtypes (including recurrent pericarditis) and secondary phenotypes. To explore mechanisms, associations with messenger RNA expression (cis-eQTL), plasma protein levels (pQTL), and CpG methylation of DNA (ASM-QTL) were assessed. Data from Iceland (deCODE genetics, 1983-2020), Denmark (Copenhagen Hospital Biobank/Danish Blood Donor Study, 1977-2022), the UK (UK Biobank, 1953-2021), the US (Intermountain, 1996-2022), and Finland (FinnGen, 1970-2022) were included. Data were analyzed from September 2022 to August 2023. Exposure Genotype. Main Outcomes and Measures Pericarditis. Results In this genome-wide association study of 4894 individuals with pericarditis (mean [SD] age at diagnosis, 51.4 [17.9] years, 2734 [67.6%] male, excluding the FinnGen cohort), associations were identified with 2 independent common intergenic variants at the interleukin 1 locus on chromosome 2q14. The lead variant was rs12992780 (T) (effect allele frequency [EAF], 31%-40%; odds ratio [OR], 0.83; 95% CI, 0.79-0.87; P = 6.67 × 10-16), downstream of IL1B and the secondary variant rs7575402 (A or T) (EAF, 45%-55%; adjusted OR, 0.89; 95% CI, 0.85-0.93; adjusted P = 9.6 × 10-8). The lead variant rs12992780 had a smaller odds ratio for recurrent pericarditis (0.76) than the acute form (0.86) (P for heterogeneity = .03) and rs7575402 was associated with CpG methylation overlapping binding sites of 4 transcription factors known to regulate interleukin 1 production: PU.1 (encoded by SPI1), STAT1, STAT3, and CCAAT/enhancer-binding protein β (encoded by CEBPB). Conclusions and Relevance This study found an association between pericarditis and 2 independent sequence variants at the interleukin 1 gene locus. This finding has the potential to contribute to development of more targeted and personalized therapy of pericarditis with interleukin 1-blocking drugs.
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Affiliation(s)
| | | | | | | | | | | | - Gisli H. Halldorsson
- deCODE genetics, Amgen, Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | - Saedis Saevarsdottir
- deCODE genetics, Amgen, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Medicine, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | | | | | - Ole B. Pedersen
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Erik Sørensen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jonas Ghouse
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Laboratory for Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anna Axelsson Raja
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Chaoqun Zheng
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Elvira Silajdzija
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Søren Albertsen Rand
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Laboratory for Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Christina Mikkelsen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Karina Banasik
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Brunak
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Hafsteinn Einarsson
- deCODE genetics, Amgen, Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Hannes Helgason
- deCODE genetics, Amgen, Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Bjarni V. Halldorsson
- deCODE genetics, Amgen, Reykjavik, Iceland
- School of Technology, Reykjavik University, Reykjavik, Iceland
| | - Brynja D. Sigurpalsdottir
- deCODE genetics, Amgen, Reykjavik, Iceland
- School of Technology, Reykjavik University, Reykjavik, Iceland
| | - Isleifur Olafsson
- Department of Clinical Biochemistry, Landspitali, National University Hospital of Iceland, Reykjavik, Iceland
| | - David O. Arnar
- deCODE genetics, Amgen, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Medicine, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Kirk U. Knowlton
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah
- School of Medicine, University of Utah, Salt Lake City
| | - Lincoln D. Nadauld
- Precision Genomics, Intermountain Healthcare, Saint George, Utah
- School of Medicine, Stanford University, Stanford, California
| | | | | | - Sisse R. Ostrowski
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Daniel F. Gudbjartssson
- deCODE genetics, Amgen, Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | - Ingileif Jonsdottir
- deCODE genetics, Amgen, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Immunology, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Henning Bundgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hilma Holm
- deCODE genetics, Amgen, Reykjavik, Iceland
| | | | - Kari Stefansson
- deCODE genetics, Amgen, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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Gallo A, Massaro MG, Camilli S, Di Francesco S, Gerardino L, Verrecchia E, Sicignano LL, Landi F, Manna R, Montalto M. Interleukin-1 Blockers in Recurrent and Acute Pericarditis: State of the Art and Future Directions. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:241. [PMID: 38399529 PMCID: PMC10890577 DOI: 10.3390/medicina60020241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
Diseases of the pericardium encompass a spectrum of conditions, including acute and recurrent pericarditis, where inflammation plays a pivotal role in the pathogenesis and clinical manifestations. Anti-inflammatory therapy indeed forms the cornerstone of treating these conditions: NSAIDs, colchicine, and corticosteroids (as a second-line treatment) are recommended by current guidelines. However, these medications come with several contraindications and are not devoid of adverse effects. In recent years, there has been an increased focus on the role of the inflammasome and potential therapeutic targets. Recurrent pericarditis also shares numerous characteristics with other autoinflammatory diseases, in which interleukin-1 antagonists have already been employed with good efficacy and safety. The objective of this review is to summarize the available studies on the use of anti-IL-1 drugs both in acute and recurrent pericarditis.
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Affiliation(s)
- Antonella Gallo
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (L.G.); (E.V.); (L.L.S.); (F.L.); (R.M.); (M.M.)
| | - Maria Grazia Massaro
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Sara Camilli
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Silvino Di Francesco
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Laura Gerardino
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (L.G.); (E.V.); (L.L.S.); (F.L.); (R.M.); (M.M.)
| | - Elena Verrecchia
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (L.G.); (E.V.); (L.L.S.); (F.L.); (R.M.); (M.M.)
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ludovico Luca Sicignano
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (L.G.); (E.V.); (L.L.S.); (F.L.); (R.M.); (M.M.)
| | - Francesco Landi
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (L.G.); (E.V.); (L.L.S.); (F.L.); (R.M.); (M.M.)
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Raffaele Manna
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (L.G.); (E.V.); (L.L.S.); (F.L.); (R.M.); (M.M.)
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Massimo Montalto
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (L.G.); (E.V.); (L.L.S.); (F.L.); (R.M.); (M.M.)
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Cinteza E, Stefan D, Iancu MA, Ioan A, Vasile CM, Vatasescu R, Cochino A. Autoinflammatory Recurrent Pericarditis Associated with a New NLRP12 Mutation in a Male Adolescent. Life (Basel) 2023; 13:2131. [PMID: 38004271 PMCID: PMC10672620 DOI: 10.3390/life13112131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023] Open
Abstract
Idiopathic recurrent pericarditis (IRP) can be the hallmark of an autoinflammatory syndrome with recurrent attacks of chest pain and symptom-free intervals following an acute episode. The recurrence rate may be 35% in the pediatric population, frequently with less severe manifestations than at the first episode. Pericarditis can be the sole clinical manifestation or may be part of a systemic autoinflammatory disease (SAID), especially in the case of a recurrence. Familial Mediterranean Fever (FMF), Tumor Necrosis Factor Receptor-Associated Periodic Syndrome (TRAPS), Mevalonate-Kinase Deficiency (MKD), nucleotide-binding oligomerization domain 2 (NOD2)-associated autoinflammatory syndrome, and others are closely related to IRP based on similar clinical manifestations and treatment responses to anti-interleukin 1 (IL-1) agents, such as anakinra, and should therefore be excluded in patients with IRP. A newly described SAID, an autosomal dominant disorder known as NLRP12-AID (nucleotide-binding leucine-rich repeat-containing receptor 12-related autoinflammatory disease) is caused by heterozygous mutations in the NLRP12 gene and most commonly affects children. Fewer than 40 pediatric patients with NLRP12-AID have been described in the medical literature, with none presenting with RP. We report a case of relapsing pericarditis responsive to anti-IL-1 therapy in a male adolescent who carried a missense mutation in the NLRP12 gene potentially causative of the excessive activation of inflammatory pathways. This is a unique case in the medical literature that associates recurrent pericarditis in an adolescent presumed to be related to the missense mutation in the NLRP12 gene. The role of the NLRP12 inflammasome in generating and maintaining recurrent pericardial inflammation should be considered.
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Affiliation(s)
- Eliza Cinteza
- Department of Pediatrics, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.C.); (A.C.)
- Department of Pediatric Cardiology, “Marie Curie” Emergency Children’s Hospital, 41451 Bucharest, Romania;
| | - Dan Stefan
- Department of Pediatric Cardiology, “Marie Curie” Emergency Children’s Hospital, 41451 Bucharest, Romania;
| | - Mihaela Adela Iancu
- Department of Internal, Family and Occupational Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Andreea Ioan
- Department of Pediatrics, “Alessandrescu Rusescu” National Institute for Mother and Child Health, 020395 Bucharest, Romania;
| | - Corina Maria Vasile
- Pediatric and Adult Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, 3300 Bordeaux, France;
| | - Radu Vatasescu
- Cardio-Thoracic Department, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
- Department of Cardiology, Clinic Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Alexis Cochino
- Department of Pediatrics, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.C.); (A.C.)
- Department of Pediatrics, “Alessandrescu Rusescu” National Institute for Mother and Child Health, 020395 Bucharest, Romania;
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Yamamoto H, Isogai J. Transient constrictive pericarditis following coxsackievirus A4 infection as a rare cause of acute mediastinitis: A case report. Heliyon 2023; 9:e19555. [PMID: 37809423 PMCID: PMC10558803 DOI: 10.1016/j.heliyon.2023.e19555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/08/2023] [Accepted: 08/25/2023] [Indexed: 10/10/2023] Open
Abstract
Background Transient constrictive pericarditis (TCP) is a distinct constrictive pericarditis (CP) subtype characterized by acute pericardial inflammation and transient constrictive physiology. If left untreated, it may progress to irreversible CP requiring pericardiectomy. However, making an early diagnosis of TCP remains difficult. Case presentation A 51-year-old man presented with fever, chest pain, and dyspnea following preceding flu symptoms. An initial investigation suggested right-sided heart failure. Laboratory results revealed elevated inflammatory markers and hepatic enzyme levels. Echocardiography revealed pericardial effusion with a normal ejection fraction and diastolic ventricular septal bounce suggestive of pericardial constriction. Computed tomography suggested acute descending mediastinitis with pericarditis and pleuritis; however, detailed examinations ruled out this possibility. The constellation of increased serological inflammation, pericardial thickness/effusion, and constrictive physiology suggested TCP, confirmed by cardiac magnetic resonance (CMR) and hemodynamic studies. CMR also revealed coexistent myocarditis. After a thorough assessment for the cause of TCP, a viral etiology was suspected. Paired serology for virus antibody titers revealed a significant increase only in coxsackievirus A4 (CVA4) titers. With prompt anti-inflammatory treatment, the patient's pericardial structure and function and concomitant inflammation of the surrounding tissues were nearly completely recovered, leading to a final diagnosis of TCP caused by CVA4. The subsequent clinical course was uneventful without recurrence at the 1-year follow-up. Conclusions Here we described the first case of TCP caused by CVA4 concurrent with mediastinitis, myocarditis, and pleuritis, all of which were successfully resolved with anti-inflammatory treatment. Acute mediastinitis secondary to TCP is rare. This case highlights the clinical importance of assessing pericardial diseases as a source of acute mediastinitis and considering CVA4 as an etiology of TCP. An evaluation including multimodal cardiac imaging and serology for virus antibody titers may be useful for an exploratory diagnosis of TCP in right-sided heart failure patients with pericardial effusion.
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Affiliation(s)
- Hiroyuki Yamamoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Jun Isogai
- Division of Radiology, Asahi General Hospital, Asahi, Japan
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Adler Y, Ristić AD, Imazio M, Brucato A, Pankuweit S, Burazor I, Seferović PM, Oh JK. Cardiac tamponade. Nat Rev Dis Primers 2023; 9:36. [PMID: 37474539 DOI: 10.1038/s41572-023-00446-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/22/2023]
Abstract
Cardiac tamponade is a medical emergency caused by the progressive accumulation of pericardial fluid (effusion), blood, pus or air in the pericardium, compressing the heart chambers and leading to haemodynamic compromise, circulatory shock, cardiac arrest and death. Pericardial diseases of any aetiology as well as complications of interventional and surgical procedures or chest trauma can cause cardiac tamponade. Tamponade can be precipitated in patients with pericardial effusion by dehydration or exposure to certain medications, particularly vasodilators or intravenous diuretics. Key clinical findings in patients with cardiac tamponade are hypotension, increased jugular venous pressure and distant heart sounds (Beck triad). Dyspnoea can progress to orthopnoea (with no rales on lung auscultation) accompanied by weakness, fatigue, tachycardia and oliguria. In tamponade caused by acute pericarditis, the patient can experience fever and typical chest pain increasing on inspiration and radiating to the trapezius ridge. Generally, cardiac tamponade is a clinical diagnosis that can be confirmed using various imaging modalities, principally echocardiography. Cardiac tamponade is preferably resolved by echocardiography-guided pericardiocentesis. In patients who have recently undergone cardiac surgery and in those with neoplastic infiltration, effusive-constrictive pericarditis, or loculated effusions, fluoroscopic guidance can increase the feasibility and safety of the procedure. Surgical management is indicated in patients with aortic dissection, chest trauma, bleeding or purulent infection that cannot be controlled percutaneously. After pericardiocentesis or pericardiotomy, NSAIDs and colchicine can be considered to prevent recurrence and effusive-constrictive pericarditis.
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Affiliation(s)
- Yehuda Adler
- Sackler Faculty of Medicine, Tel Aviv University, Bnei Brak, Israel.
- College of Law and Business, Ramat Gan, Israel.
| | - Arsen D Ristić
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
| | - Massimo Imazio
- Cardiothoracic Department, Cardiology, University Hospital Santa Maria della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Antonio Brucato
- Department of Biomedical and Clinical Sciences, Fatebenefratelli Hospital, The University of Milan, Milan, Italy
| | - Sabine Pankuweit
- Department of Internal Medicine-Cardiology, Philipps University Marburg, Marburg, Germany
| | - Ivana Burazor
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Institute for Cardiovascular Diseases "Dedinje" and Belgrade University, Faculty of Medicine, Belgrade, Serbia
| | - Petar M Seferović
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Kostelecky N, Kreutz K, Lin CY. Sensitivity of Antemortem Imaging for Pericarditis: An Institutional Experience. Am J Forensic Med Pathol 2023; 44:21-24. [PMID: 36580385 DOI: 10.1097/paf.0000000000000808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
ABSTRACT Pericarditis is a challenging diagnosis with nonspecific manifestations, significant clinical implications, and possible mortality. The advancement of imaging, such as echocardiography, computed tomography (CT), and magnetic resonance imaging (MRI), has improved the sensitivity of diagnosis, although limitations remain. In this study, we investigated the prevalence of pericarditis identified at autopsy and correlated these findings with antemortem imaging studies and clinical information. Thirty-four decedents were identified in our archival autopsy records (prevalence, 1.23%) from 2010 to 2021 with a postmortem diagnosis of pericarditis. Thirty-five antemortem imaging studies were performed on 32 decedents, of which CT was the most common (18/35, 51.4%). The sensitivity of antemortem imaging was poor, with CT showing the highest sensitivity at 16.7% (3/18), while echocardiography studies, transthoracic (TTE) and transesophageal (TEE), each had a sensitivity of 0.0%. Pericarditis was determined as the immediate cause of death by autopsy in 13 decedents, of which 3 were diagnosed antemortem. It was considered contributory to the death in 6 decedents, none of which were diagnosed antemortem. In summary, antemortem imaging has limited utility in the diagnosis of pericarditis. It is imperative to examine the pericardium during autopsy to identify a possible cause of death or contributing factor.
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Affiliation(s)
- Nicolas Kostelecky
- From the Department of Pathology, Northwestern Memorial Hospital Feinberg School of Medicine, Chicago, IL
| | - Kasey Kreutz
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO
| | - Chieh-Yu Lin
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO
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Karasu BB, Akin B. Can Asthma Cause Pericardial Effusion? Insights Into an Intriguing Association. Tex Heart Inst J 2023; 50:491986. [PMID: 37011363 PMCID: PMC10178645 DOI: 10.14503/thij-22-7867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
BACKGROUND Pericardial effusion (PE) is a commonly encountered condition in clinical practice, but its etiology can be difficult to identify, with many cases remaining classified as idiopathic. This study aimed to investigate whether an association exists between asthma and idiopathic PE (IPE). METHODS Patients who had been diagnosed with PE in the authors' outpatient cardiology clinics between March 2015 and November 2018 were retrospectively analyzed. The study population was divided into 2 groups-non-IPE (NIPE) and IPE-based on whether a cause had been identified. Demographic, laboratory, and clinical data for the 2 groups were examined statistically. RESULTS A total of 714 patients were enrolled in the study after exclusion of 40 cases. Of these 714 patients, 558 were allocated to the NIPE group and 156 to the IPE group (NIPE group median [IQR] age, 50 [41-58] years vs IPE group median [IQR] age, 47 [39-56] years; P = .03). Asthma was significantly more prevalent among patients in the IPE group than among those in the NIPE group (n = 54 [34.6%] vs n = 82 [14.7%]; P < .001). In multivariate logistic regression analysis, asthma (odds ratio, 2.67 [95% CI, 1.53-4.67]; P = .001) was found to be an independent predictor of IPE. In the IPE group, patients with asthma had either mild or moderate PE, with the right atrium being the most common location in these patients. CONCLUSION Asthma was an independent predictor of mild to moderate IPE. The right atrium was the most frequently encountered location for PE in patients with asthma.
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Affiliation(s)
- Betul Banu Karasu
- Department of Cardiology, Etimesgut Sehit Sait Erturk State Hospital, Ankara, Turkey
| | - Berna Akin
- Department of Chest Diseases, Ankara Pursaklar State Hospital, Ankara, Turkey
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Kapačinskaitė M, Gabartaitė D, Šatrauskienė A, Sakaitė I, Maneikienė VV, Zorinas A, Janušauskas V. A Rare Case of Primary Purulent Pericarditis Caused by Streptococcus constellatus. Medicina (B Aires) 2023; 59:medicina59010159. [PMID: 36676783 PMCID: PMC9866074 DOI: 10.3390/medicina59010159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/14/2023] Open
Abstract
Background: Bacteria-caused acute pericarditis is a very rare entity. It is usually associated with an underlying infection or compromised immune system. Primary purulent pericarditis in a previously healthy individual is highly unexpected; therefore, it is likely to have a delayed diagnosis and poor outcomes. Case: We report a case of an adult immunocompetent patient with primary bacterial pericarditis caused by a member of the commensal oral flora Streptococcus constellatus. The patient presented with septic shock and cardiac tamponade, and was further complicated with constrictive pericarditis, which was successfully treated with pericardiectomy. Conclusions: Bacterial pericarditis is a fulminant disease with a high mortality and complication rate. Fast recognition and prompt therapy are required to achieve a full recovery.
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Affiliation(s)
- Medeinė Kapačinskaitė
- Faculty of Medicine, Vilnius University, M.K. Čiurlionio g. 21, 03101 Vilnius, Lithuania
- Correspondence:
| | - Dovilė Gabartaitė
- Department of Cardiology, Center of Cardiology and Angiology, Vilnius University Hospital Santaros Clinics, Santariškių g. 2, 08661 Vilnius, Lithuania
| | - Agnė Šatrauskienė
- Faculty of Medicine, Vilnius University, M.K. Čiurlionio g. 21, 03101 Vilnius, Lithuania
| | - Ieva Sakaitė
- Faculty of Medicine, Vilnius University, M.K. Čiurlionio g. 21, 03101 Vilnius, Lithuania
| | | | - Aleksejus Zorinas
- Faculty of Medicine, Vilnius University, M.K. Čiurlionio g. 21, 03101 Vilnius, Lithuania
| | - Vilius Janušauskas
- Faculty of Medicine, Vilnius University, M.K. Čiurlionio g. 21, 03101 Vilnius, Lithuania
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Easton A, Joret M, Xian S, Ternouth I. Pericardial effusion and tamponade in the context of herpes zoster: a novel occurrence. Eur Heart J Case Rep 2022; 7:ytac459. [PMID: 36600801 PMCID: PMC9800266 DOI: 10.1093/ehjcr/ytac459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/06/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022]
Abstract
Background Pericarditis and pericardial effusion are relatively common hospital presentations, which rarely result in cardiac tamponade. The aetiology is often undetermined and presumed idiopathic or viral. This article reviews varicella zoster virus (VZV)-associated pericardial effusion and peri/myopericarditis and constitutes the first report of VZV-associated cardiac tamponade in the adult population. Case summary We report the case of a 59-year-old woman who presented to hospital with pleuritic chest pain, haemodynamic instability, and a recent herpes zoster rash in the left T1 distribution. Computed tomography revealed a large pericardial effusion, and echocardiography showed features of cardiac tamponade. The patient was treated with pericardial drainage. Aspirate analysis revealed abundant polynuclear cells and histocytes with no organism. Polymerase chain reaction did not determine a cause. Discussion There are 13 reported cases of VZV-associated peri/myopericarditis in adults in the literature published in the English language. Of these, only three patients had a pericardial effusion. Aetiological diagnosis of an effusion is challenging and rarely made on virological grounds but rather on clinical features. Varicella zoster virus-associated pericardial effusion should be considered in patients presenting with haemodynamic instability and a dermatomal rash affecting the C3-C5 and T1-T4 distributions.
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Affiliation(s)
| | - Maximilian Joret
- Department of General Surgery, Taranaki Base Hospital, David Street, Westown, New Plymouth 4310, New Zealand
| | - Susan Xian
- Department of General Medicine, Taranaki Base Hospital, David Street, Westown, New Plymouth 4310, New Zealand
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10
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Ivaturi K, Tsukhai V, Hassan WM. Influenza Type B Complicates a Previously Undiagnosed Case of Pericarditis. Cureus 2022; 14:e30810. [DOI: 10.7759/cureus.30810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
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11
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Adefuye MA, Manjunatha N, Ganduri V, Rajasekaran K, Duraiyarasan S, Adefuye BO. Tuberculosis and Cardiovascular Complications: An Overview. Cureus 2022; 14:e28268. [PMID: 36158349 PMCID: PMC9491794 DOI: 10.7759/cureus.28268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/25/2022] Open
Abstract
Tuberculosis (TB) is a dominant cause of mortality from a single infectious disease agent. It is a global health issue that has been tagged as a public health emergency for decades. The disease process, which is caused by Mycobacterium tuberculosis (MTB), affects the respiratory system as well as many other organ systems in the body, such as the lymphatic system, central nervous system (CNS), gastrointestinal system, and cardiovascular system (CVS). Generally, cardiovascular diseases are the leading cause of death worldwide, with most of the mortality in low and middle-income countries. Also, the high mortality rate of TB is skewed to these regions, making the mortality of TB with CVS involvement exceptionally high. The multisystemic involvement of TB impacts the cardiovascular system in various forms. While pericarditis caused by TB is quite common, other complications like myocarditis, coronary artery disease, and aortitis are rarer, necessitating a high index of suspicion and holistic management. This article reviews the pathophysiology of cardiovascular complications in TB, highlighting mechanisms of occurrence, common complications, management protocols, and prognostic factors. Our review highlights some of the gaps in understanding cardiovascular complications in TB, necessitating further research to investigate causal mechanisms and treatment.
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12
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Kumar S, Khubber S, Reyaldeen R, Agrawal A, Cremer PC, Imazio M, Kwon DH, Klein AL. Advances in Imaging and Targeted Therapies for Recurrent Pericarditis: A Review. JAMA Cardiol 2022; 7:975-985. [PMID: 35976625 DOI: 10.1001/jamacardio.2022.2584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Pericarditis is the most common form of pericardial disease. Recurrence of pericarditis affects 15% to 30% of patients after the initial episode of pericarditis. Up to 50% of patients with the first recurrence have additional recurrences. These patients often progress to have colchicine-resistant and corticosteroid-dependent disease. Rapidly evolving cardiac magnetic resonance imaging techniques and novel targeted therapies have paved the way for imaging-guided therapy for recurrent pericarditis. However, the optimal application of these recent advances remains unclear. Observations A search was conducted using the PubMed and Cochrane databases for English-language studies, management guidelines, meta-analyses, and review articles published until April 2022 on recurrent pericarditis. Following the 2015 European Society of Cardiology guidelines for the diagnosis and management of pericardial diseases, new clinical trials and registry data have emerged that demonstrate the efficacy of interleukin-1 blockers in recurrent pericarditis. In addition, new observational data have come to light supporting the use of cardiac magnetic resonance imaging in the diagnosis, risk stratification, and management of such patients. Conclusions and Relevance Advances in imaging and targeted therapies have led to a paradigm shift in the management of recurrent pericarditis. This narrative review summarizes the established and emerging data on the diagnosis and treatment of recurrent pericarditis with special emphasis on the role of cardiac magnetic resonance imaging and interleukin-1 blockers in the current era of tailored therapy for recurrent pericarditis.
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Affiliation(s)
- Sachin Kumar
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shameer Khubber
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Reza Reyaldeen
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ankit Agrawal
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul C Cremer
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Deborah H Kwon
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
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13
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Ashram WY, Talab SK, Alotaibi RM, Baarma RW, Al Nemer ZA, Alshareef MA, AlGhamdi HH, Alsubhi RK. Descriptive Study of Pericarditis Outcomes in Different Etiologies and Risk Factors: A Retrospective Record Review. Cureus 2022; 14:e27301. [PMID: 36039227 PMCID: PMC9403241 DOI: 10.7759/cureus.27301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/11/2022] Open
Abstract
Background: Pericarditis is an inflammatory pericardial disorder that can be caused by several infectious and non-infectious illnesses. Coronavirus disease 2019 (COVID-19) was recently added to the long list of pericarditis causes. As a result, this study aims to look at the incidence of various etiologies of pericarditis, including post-COVID-19 vaccine and risk factors, at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. Methods: Between 2012 and 2022, all male and female patients diagnosed with acute, chronic, or constrictive pericarditis at the King Abdulaziz University Hospital clinic were included in this retrospective study, which took place in June 2022. Data were collected from the hospital's medical records, including the patient's demographic information, pericarditis history, medical history, social background, laboratory tests, Echocardiogram (ECHO) and electrocardiogram (ECG) readings, and medication history. Associations were tested using univariate and bivariate analysis. Results: Acute pericarditis was diagnosed in 59 (89.1%) patients and the most common symptoms were chest pain and shortness of breath (SOB) followed by fever and cough.Idiopathic pericarditis was the primary etiology 30 (46.9%) with male predominance 25 (55.6%), followed by infections and then cardiac presenting primarily with chest pain 25 (83.3%). In comparison, the most common presentation in females was autoimmune, as seen in eight patients (42.1%). Most patients required aspirin, ibuprofen, and colchicine. Among outcomes, of a total of 64 patients, five died within 30 days. Moreover, four (7.5%) experienced subsequent cardiac tamponades, which was mainly due to malignancy (50%) (p<0.05). Conclusion: There was a substantial relationship between malignancy and developing morbid complications, with 59 patients out of 64 getting acute pericarditis and the remainder chronic and constrictive pericarditis with idiopathic pericarditis being the leading causes.
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14
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Divchev D, Schnurbus M, Schieffer B. [What's new in pericardial disease?]. Dtsch Med Wochenschr 2022; 147:704-710. [PMID: 35636422 DOI: 10.1055/a-1593-9470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pericardial disease represents a large diversity of inflammation related injury of the pericardium. Multifactorial causes may contribute to acute and recurrent pericarditis, pericardial effusion without major hemodynamic compromise, cardiac tamponade or constrictive pericarditis. Currently, inflammatory pericardial pathologies are observed in cases of SARS-CoV-2-infection or after vaccination. Beside established anti-inflammatory therapeutic strategies with NSAID, corticosteroids and colchicine, auto-inflammation and inflammasomes seam to offer more specific targets for advanced treatment options.
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Affiliation(s)
- Dimitar Divchev
- Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Phillips-Universität Marburg, Universitätsklinik Gießen und Marburg, Campus Marburg
| | - Mareike Schnurbus
- Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Phillips-Universität Marburg, Universitätsklinik Gießen und Marburg, Campus Marburg
| | - Bernhard Schieffer
- Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Phillips-Universität Marburg, Universitätsklinik Gießen und Marburg, Campus Marburg
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15
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Mahalwar G, Kumar A, Agrawal A, Bhat A, Furqan M, Yesilyaprak A, Verma BR, Chan N, Schleicher M, Neto MLR, Xu B, Jellis CL, Klein AL. Pericardial Involvement in Sarcoidosis. Am J Cardiol 2022; 170:100-104. [PMID: 35227500 DOI: 10.1016/j.amjcard.2022.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/10/2022] [Accepted: 01/20/2022] [Indexed: 12/20/2022]
Abstract
Pericardial disease secondary to sarcoidosis is a rare clinical entity with no observational studies in previous research. Therefore, we evaluated reported cases of pericarditis because of sarcoidosis to further understand its diagnosis and management. We performed a systematic review of previous research until December 16, 2020 in MEDLINE, Embase, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science. Case reports and case series demonstrating pericardial involvement in sarcoidosis were included. Fourteen reports with a total of 27 patients were identified. Dyspnea (82%) was the most common presentation, with the lungs being the primary site of sarcoidosis in most patients (77%). The most frequently encountered pericardial manifestations were pericardial effusion (89%), constrictive pericarditis and cardiac tamponade (48%). Management of these patients included use of corticosteroids (82%), colchicine (11%), and nonsteroidal anti-inflammatory agents (7%). Similar to the general population, the most common intervention in these patients was pericardiocentesis (59%), pericardial window (30%), and pericardiectomy (19%). Overall, the majority of this population (70%) achieved clinical improvement during median follow-up time of 8 months. In conclusion, the prevalence and incidence of sarcoid-induced pericarditial disease remain unclear. Clinical manifestations of pericardial involvement are variable, though many patients present with asymptomatic pericardial effusions. No consensus exists on the treatment of this special population, but corticosteroids and combination therapies are considered first-line therapies because of their efficacy in suppressing pericardial inflammation and underlying sarcoidosis. Patients with refractory cases of pericarditis may also benefit therapeutically from the addition of nonsteroidal anti-inflammatory agents, colchicine, and/or biologics.
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16
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Incidence of Myopericarditis and Myocardial Injury in Coronavirus Disease 2019 Vaccinated Subjects. Am J Cardiol 2022; 164:123-130. [PMID: 34852929 PMCID: PMC8627580 DOI: 10.1016/j.amjcard.2021.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 02/08/2023]
Abstract
Several recent publications have described myopericarditis cases after the coronavirus disease 2019 (COVID-19) vaccination. However, it is uncertain if these cases occurred secondary to the vaccination or more common etiologies of myopericarditis. To help determine whether a correlation exists between COVID-19 vaccination and myopericarditis, the present study compared the gender-specific cumulative incidence of myopericarditis and myocardial injury in a cohort of COVID-19 vaccinated patients at a tertiary care center in 2021 with the cumulative incidence of these conditions in the same subjects exactly 2 years earlier. We found that the age-adjusted incidence rate of myopericarditis in men was higher in the vaccinated than the control population, rate ratio 9.7 (p = 0.04). However, the age-adjusted incidence rate of myopericarditis in women was no different between the vaccinated and control populations, rate ratio 1.28 (p = 0.71). We further found that the rate of myocardial injury was higher in both men and women in 2021 than in 2019 both before and after vaccination, suggesting that some of the apparent increase in the diagnosis of myopericarditis after vaccination may be attributable to factors unrelated to the COVID-19 vaccinations. In conclusion, our study reaffirms the apparent increase in the diagnosis of myopericarditis after COVID-19 vaccination in men but not in women, although this finding may be confounded by increased rates of myocardial injury in 2021. The benefits of COVID-19 vaccination to individual and public health clearly outweigh the small potential increased risk of myopericarditis after vaccination.
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17
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Alihajdaraj R, Grbolar A, Krasniqi X, Bekteshi T, Bakalli A. Echocardiography and Laboratory Factors Associated With Prolonged Postoperative Pericardial Effusion. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793211070233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Pericardial effusion is a frequent finding in patients who undergo cardiac surgery. There are currently limited data providing information regarding the factors that may contribute to postoperative pericarditis. The aim was to evaluate laboratory and echocardiographic features that may influence the presence of pericardial effusion 6 to 8 weeks following coronary artery bypass grafting (CABG). Materials and Methods: This was a prospective cross-sectional study that included 90 patients after CABG operation who were divided into two groups. A total of 32 (35.56%) patients with pericardial effusion on follow-up echocardiography formed the first group and 58 patients without pericardial effusion the second group, which were compared in respect to components that were taken prior to the operation. Results: The groups did not differ regarding sex (males 65.62% vs 63.79%, P = .86) or age (59.59 ± 9.29 vs 61.69 ± 10.71, P = .35). Platelet count (184.74 ± 58.79 vs 222.62 ± 88.97, P = .03) and left ventricular (LV) global longitudinal strain (GLS) (−14.64 ± 6.86 vs −16.96 ± 4.1, P = .04) demonstrated statistical significance. Conclusion: Prolonged postoperative pericardial effusion in small amounts may be found in patients, with preoperative lower thrombocyte count and LV GLS, which could be possible predisposing factors.
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Affiliation(s)
| | - Adem Grbolar
- Clinic of Invasive Cardiology and Cardiosurgery, University Clinical Center of Kosovo, Pristina, Kosovo
| | - Xhevdet Krasniqi
- Clinic of Invasive Cardiology and Cardiosurgery, University Clinical Center of Kosovo, Pristina, Kosovo
- Faculty of Medicine, University of Prishtina, Pristina, Kosovo
| | - Tefik Bekteshi
- Clinic of Invasive Cardiology and Cardiosurgery, University Clinical Center of Kosovo, Pristina, Kosovo
| | - Aurora Bakalli
- Clinic of Invasive Cardiology and Cardiosurgery, University Clinical Center of Kosovo, Pristina, Kosovo
- Faculty of Medicine, University of Prishtina, Pristina, Kosovo
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18
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Bedel C, Selvi F, Korkut M. Immature granulocytes: A novel biomarker of acute pericarditis. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2022. [DOI: 10.4103/injms.injms_60_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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19
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Lamprinos N, Ladomenou F, Stefanaki S, Foukarakis E, Vlachaki G. Pericarditis Following Recovery From COVID-19 Infection in a 15-Year-Old Boy: A Postinflammatory Immune-Mediated Presentation or a New-Onset Autoimmune Disease. Cureus 2021; 13:e19255. [PMID: 34881119 PMCID: PMC8643140 DOI: 10.7759/cureus.19255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 11/22/2022] Open
Abstract
As the COVID-19 pandemic evolves, the medical community continues to report a variety of clinical manifestations of SARS-CoV-2 in the pediatric population. Although younger age groups experience less severe disease, attention is given to the immunologic manifestations of the disease. Pericarditis is a rare cardiac complication of COVID-19 infection. We discuss the first case of delayed presentation of pericarditis following recovery from COVID-19 infection in the pediatric population. A 15-year-old male adolescent presented to the emergency department (ED) with a two-day history of left-sided, sub-sternal chest pain that worsened during inspiration and a low-grade fever. Twenty days prior to this presentation, the patient experienced fever and was tested positive for SARS-CoV-2. His family history was remarkable for Hashimoto thyroiditis and rheumatoid arthritis, with his mother having experienced 18 episodes of pericarditis during the exacerbations of her disease. RT-PCR for SARS-CoV-2 was negative on this occasion and the serology assay identified positive IgG antibodies against the virus. The ECG was suggestive for pericarditis and the diagnosis was confirmed by the presence of pericardial effusion on ECHO. The rest of the aetiological investigations for pericarditis were negative. In view of the strong family history of autoimmunity, questions were raised in the medical team of our hospital regarding the etiology of his pericarditis and on whether it represented a postinflammatory immune-mediated presentation of SARS-CoV-2 or a new-onset autoimmune disease.
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Affiliation(s)
- Nikolas Lamprinos
- Department of Pediatrics, Venizeleion General Hospital, Heraklion Crete, GRC
| | - Fani Ladomenou
- Department of Pediatrics, Venizeleion General Hospital, Heraklion Crete, GRC
| | - Sofia Stefanaki
- Department of Pediatrics, Venizeleion General Hospital, Heraklion Crete, GRC
| | | | - Georgia Vlachaki
- Department of Pediatrics, Venizeleion General Hospital, Heraklion Crete, GRC
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20
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Casula M, Andreis A, Avondo S, Imazio M. Post cardiac injury syndromes: diagnosis and management. Panminerva Med 2021; 63:270-275. [PMID: 34738772 DOI: 10.23736/s0031-0808.21.04211-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Post cardiac injury syndromes (PCIS) are becoming increasingly common, due to the growing number of cardiovascular procedures (cardiac surgery, percutaneous interventions) and the high burden of cardiovascular diseases such as acute coronary syndromes. This review aims to provide an overview of the main clinical characteristics of PCIS, along with their management in clinical practice.
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Affiliation(s)
- Matteo Casula
- Department of Cardiology, Città della Salute e della Scienza, Turin, Italy
| | - Alessandro Andreis
- Department of Cardiology, Città della Salute e della Scienza, Turin, Italy
| | - Stefano Avondo
- Department of Cardiology, Città della Salute e della Scienza, Turin, Italy
| | - Massimo Imazio
- Unit of Cardiology, Cardiothorace Department, University Hospital "Santa Maria della Misericordia", Udine, Italy -
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21
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Jain V, Chhabra G, Chetrit M, Bansal A, Berglund F, Montanè B, Furqaan MM, Bachour SP, Kontzias A, Villa-Forte A, Aronow WS, Imazio M, Cremer PC, Klein AL. Role of non-invasive multimodality imaging in autoimmune pericarditis. Eur Heart J Cardiovasc Imaging 2021; 22:1228-1240. [PMID: 34333596 DOI: 10.1093/ehjci/jeab131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/17/2021] [Indexed: 01/24/2023] Open
Abstract
Systemic autoimmune diseases are an important cause of pericardial involvement and contribute to up to ∼22% cases of pericarditis with a known aetiology. The underlying mechanism for pericardial involvement varies with each systemic disease and leads to a poor understanding of its management. Multimodality imaging establishes the diagnosis and determines the type and extent of pericardial involvement. In this review, we elaborate upon various pericardial syndromes associated with different systemic autoimmune and autoinflammatory diseases and the multitude of imaging modalities that can be used to further characterize autoimmune pericardial involvement. Lastly, these forms of pericarditis have a greater likelihood of recurrence, and clinicians need to understand their unique treatment approaches to improve patient outcomes.
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Affiliation(s)
- Vardhmaan Jain
- Heart,Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Garvit Chhabra
- Department of Internal Medicine, University of Louisville, 530 S Jackson St, Louisville, KY 40202, USA
| | - Michael Chetrit
- Heart,Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Agam Bansal
- Heart,Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Felix Berglund
- Heart,Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Bryce Montanè
- Heart,Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Muhammad M Furqaan
- Heart,Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Salaam P Bachour
- Heart,Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Apostolos Kontzias
- Department of Rheumatology, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY 11794, USA
| | - Alexandra Villa-Forte
- Heart,Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Centre, 100 Woods Rd, Valhalla, NY 10595, USA
| | - Massimo Imazio
- University Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, Corso Bramante, 88, 10126 Torino, TO, Italy
| | - Paul C Cremer
- Center for Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Allan L Klein
- Center for Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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22
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Carubbi F, Alunno A, Leone S, Di Gregorio N, Mancini B, Viscido A, Del Pinto R, Cicogna S, Grassi D, Ferri C. Pericarditis after SARS-CoV-2 Infection: Another Pebble in the Mosaic of Long COVID? Viruses 2021; 13:v13101997. [PMID: 34696427 PMCID: PMC8540566 DOI: 10.3390/v13101997] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 12/15/2022] Open
Abstract
With the emerging success of the COVID-19 vaccination programs, the incidence of acute COVID-19 will decrease. However, given the high number of people who contracted SARS-CoV-2 infection and recovered, we will be faced with a significant number of patients with persistent symptoms even months after their COVID-19 infection. In this setting, long COVID and its cardiovascular manifestations, including pericarditis, need to become a top priority for healthcare systems as a new chronic disease process. Concerning the relationship between COVID-19 and pericardial diseases, pericarditis appears to be common in the acute infection but rare in the postacute period, while small pericardial effusions may be relatively common in the postacute period of COVID-19. Here, we reported a series of 7 patients developing pericarditis after a median of 20 days from clinical and virological recovery from SARS-CoV-2 infection. We excluded specific identifiable causes of pericarditis, hence we speculate that these cases can be contextualized within the clinical spectrum of long COVID. All our patients were treated with a combination of colchicine and either ASA or NSAIDs, but four of them did not achieve a clinical response. When switched to glucocorticoids, these four patients recovered with no recurrence during drug tapering. Based on this observation and on the latency of pericarditis occurrence (a median of 20 days after a negative nasopharyngeal swab), could be suggested that post-COVID pericarditis may be linked to ongoing inflammation sustained by the persistence of viral nucleic acid without virus replication in the pericardium. Therefore, glucocorticoids may be a suitable treatment option in patients not responding or intolerant to conventional therapy and who require to counteract the pericardial inflammatory component rather than direct an acute viral injury to the pericardial tissue.
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Affiliation(s)
- Francesco Carubbi
- Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.A.); (S.L.); (N.D.G.); (B.M.); (A.V.); (R.D.P.); (D.G.); (C.F.)
- Department of Medicine, ASL 1 Avezzano-Sulmona-L’Aquila, San Salvatore Hospital, 67100 L’Aquila, Italy;
- Correspondence:
| | - Alessia Alunno
- Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.A.); (S.L.); (N.D.G.); (B.M.); (A.V.); (R.D.P.); (D.G.); (C.F.)
| | - Silvia Leone
- Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.A.); (S.L.); (N.D.G.); (B.M.); (A.V.); (R.D.P.); (D.G.); (C.F.)
| | - Nicoletta Di Gregorio
- Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.A.); (S.L.); (N.D.G.); (B.M.); (A.V.); (R.D.P.); (D.G.); (C.F.)
- Department of Medicine, ASL 1 Avezzano-Sulmona-L’Aquila, San Salvatore Hospital, 67100 L’Aquila, Italy;
| | - Bernardina Mancini
- Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.A.); (S.L.); (N.D.G.); (B.M.); (A.V.); (R.D.P.); (D.G.); (C.F.)
- Department of Medicine, ASL 1 Avezzano-Sulmona-L’Aquila, San Salvatore Hospital, 67100 L’Aquila, Italy;
| | - Angelo Viscido
- Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.A.); (S.L.); (N.D.G.); (B.M.); (A.V.); (R.D.P.); (D.G.); (C.F.)
| | - Rita Del Pinto
- Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.A.); (S.L.); (N.D.G.); (B.M.); (A.V.); (R.D.P.); (D.G.); (C.F.)
| | - Sabrina Cicogna
- Department of Medicine, ASL 1 Avezzano-Sulmona-L’Aquila, San Salvatore Hospital, 67100 L’Aquila, Italy;
- Cardiology and Coronary Care Unit, San Salvatore Hospital, 67100 L’Aquila, Italy
| | - Davide Grassi
- Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.A.); (S.L.); (N.D.G.); (B.M.); (A.V.); (R.D.P.); (D.G.); (C.F.)
| | - Claudio Ferri
- Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (A.A.); (S.L.); (N.D.G.); (B.M.); (A.V.); (R.D.P.); (D.G.); (C.F.)
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Jaryal A, Vikrant S, Sarkar M, Asotra S, Gupta D, Agarwal S. A case report of pleuro-pericardial effusion in a patient on hemodialysis and a cardiac pacemaker. Semin Dial 2021; 34:323-325. [PMID: 34190363 DOI: 10.1111/sdi.12996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There are multiple causes of pleuro-pericardial effusion (PPEF) and more so in a patient with end-stage renal disease (ESRD). Postcardiac injury syndrome (PCIS) is a loosely defined term for occurrence of pericardial and/or pleural effusion (PLEF), low-grade fever, with or without systemic upset, which occurs after myocardial infarction (MI), and other cardiac interventions. PPEF is one of its salient manifestations. We report occurrence of PCIS, presenting as pericardial effusion and massive PLEF, after insertion of cardiac pacemaker in a patient with ESRD, on maintenance hemodialysis (MHD). It was successfully managed with a short course of oral steroids.
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Affiliation(s)
- Ajay Jaryal
- Indira Gandhi Medical College, Shimla, India.,Department of Medicine, All India Institute of Medical Sciences, Bilaspur, 174001, India
| | | | | | | | - Dalip Gupta
- Indira Gandhi Medical College, Shimla, India
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Serati L, Carnovale C, Maestroni S, Brenna M, Smeriglia A, Massafra A, Bizzi E, Picchi C, Tombetti E, Brucato A. Management of acute and recurrent pericarditis in pregnancy. Panminerva Med 2021; 63:276-287. [PMID: 33687181 DOI: 10.23736/s0031-0808.21.04198-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This review summarizes the currently available evidence on the management of acute and recurrent pericarditis during pregnancy, focusing on the safety of diagnostic procedures and treatment options for the mother and foetus. Family planning should be addressed in women with recurrent pericarditis of reproductive age and adjustment of therapy should be considered before a planned pregnancy. The treatment of pericarditis in pregnancy is similar to that for non-pregnant women but considers current knowledge on drug safety during pregnancy and lactation. The largest case series on this topic described 21 pregnancies with idiopathic recurrent pericarditis. Pregnancy should be planned in a phase of disease quiescence. Non-steroidal anti-inflammatory drugs can be used at high dosages until the 20th week of gestation (except low-dose aspirin 100 mg/die). Colchicine is allowed until gravindex positivity; after this period, administration of this drug during pregnancy and lactation should be discussed with the mother if its use is important to control recurrent pericarditis. Prednisone is safe if used at low-medium doses (2,5 - 10 mg/die). General outcomes of pregnancy in patients with pericarditis are good when the mothers are followed by a multidisciplinary team with experience in the field.
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Affiliation(s)
- Lisa Serati
- Department of Internal Medicine, Fatebenefratelli Hospital, Milan, Italy -
| | - Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, Luigi Sacco University Hospital, Università di Milano, Milan, Italy
| | - Silvia Maestroni
- Department of Internal Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Martino Brenna
- Department of Internal Medicine, Fatebenefratelli Hospital, Milan, Italy
| | - Aurora Smeriglia
- Department of Internal Medicine, Fatebenefratelli Hospital, Milan, Italy
| | - Agnese Massafra
- Department of Internal Medicine, Fatebenefratelli Hospital, Milan, Italy
| | - Emanuele Bizzi
- Department of Internal Medicine, Fatebenefratelli Hospital, Milan, Italy
| | - Chiara Picchi
- Department of Internal Medicine, Fatebenefratelli Hospital, Milan, Italy
| | - Enrico Tombetti
- Department of Biomedical and Clinical Sciences, University of Milan, Fatebenefratelli Hospital, Milan, Italy
| | - Antonio Brucato
- Department of Biomedical and Clinical Sciences, University of Milan, Fatebenefratelli Hospital, Milan, Italy
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Ferreira J, Luis M, Baptista R, Monteiro S, Gonçalves L. Investigating the Usefulness of European Society of Cardiology Guidelines for Hospitalization in Acute Pericarditis at a Single Tertiary Center. Cureus 2021; 13:e13189. [PMID: 33717732 PMCID: PMC7942027 DOI: 10.7759/cureus.13189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 11/09/2022] Open
Abstract
Background The European Society of Cardiology (ESC) guidelines for the diagnosis and management of pericardial diseases identify predictive factors of poor prognosis and advise either in favor or against hospitalization accordingly. We aim to evaluate the adequacy of hospitalization criteria in a cohort of patients presenting to the emergency department (ED) with acute pericarditis. Methods Retrospective analysis of patients admitted to ED with acute pericarditis, from 2009 to 2019. During ED stay, all patients were evaluated by a cardiologist who decided if the patient was to be discharged or hospitalized. Hospitalized and discharged patients were compared regarding the primary outcome, defined by a composite of: the need for pericardiocentesis and/or cardiac surgery, pericarditis recurrence, and all-cause death. The clinical decision was then counterpoised with ESC guidelines. Results A total of 192 patients were included in the analysis (median age 44.5 years old, 83.3% male) of which 87 (45.5%) were hospitalized. A total of 25% registered the primary outcome, mainly due to acute pericarditis recurrence, occurring in 21.9%. Predictors of recurrence were: glucocorticoid therapy (Odds Ratio [OR]=11.93, 95% Confidence Inirtval [CI] 3.13-45.5, p<0.001), fever at admission (OR=2.67, 95% CI 1.29-5.49, p=0.008), immunosuppression (OR=4.03, 95% CI 1.280-12.659, p=0.017) and increased cardiothoracic index (OR 3.85, CI 95% 1.67-8.86, p=0.002). Regarding hospitalisation/discharge decision, the ESC guidelines were respected in 73.4% of the cases. However, no significant difference in the primary outcome was noted whether the ESC guidelines were respected or not (27.5% vs. 24.3%, p=0.707). Conclusions Discrepancy between current guidelines and the clinical decision did not translate into a different outcome.
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Affiliation(s)
- João Ferreira
- Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - Mariana Luis
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - Rui Baptista
- Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - Sílvia Monteiro
- Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - Lino Gonçalves
- Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
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Bonaventura A, Vecchié A, Mauro AG, Brucato AL, Imazio M, Abbate A. An update on the pathophysiology of acute and recurrent pericarditis. Panminerva Med 2020; 63:249-260. [PMID: 33337127 DOI: 10.23736/s0031-0808.20.04205-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pericarditis is an inflammatory disease of the pericardium. Progress has been done in recent years in the understanding of its pathophysiology. In particular, pre-clinical and clinical studies have contributed to increasing our knowledge on the role of interleukin (IL)-1 and NLRP3 (NACHT, leucine- rich repeat, and pyrin domain- containing protein 3) inflammasome. Based on current evidence, pericarditis should be considered as an inflammatory reaction to various stimuli, including chemical/physical, infectious, or ischemic ones, with a viral infection being a common etiology. Interaction of pathogens or irritants with toll-like receptor (TLRs) and stimulation of IL-1 receptor by IL-1α and IL-1β lead to an increased transcription of pro-inflammatory genes, including those needed for NLRP3 inflammasome assembly. This pathway is confirmed indirectly by the beneficial effect of colchicine (an indirect NLRP3 inflammasome inhibitor) and IL-1 blockers in patients with recurrent pericarditis. More recently, a direct evidence of the NLRP3 inflammasome within the inflamed pericardium has been provided as well. It may, however, occur that selfantigens on the surface of mesothelial cells or microbial peptides may stimulate autoreactive T cells along with B cells producing anti-heart antibodies, although less evidence is available on this. Some uncertainties still remain about the role of neutrophils, neutrophil extracellular traps (NETs), and pericardial interstitial cells in recurrent and constrictive pericarditis. Unraveling these aspects might have a direct impact on the development of novel targeted therapies, especially considering the increasing number of drugs targeting NETs.
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Affiliation(s)
- Aldo Bonaventura
- Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Richmond, VA, USA - .,First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy - .,Internal Medicine Unit, Department of Medicine and Surgery, University of Insubria-Ospedale Di Circolo di Varese, ASST Dei Sette Laghi, Varese, Italy -
| | - Alessandra Vecchié
- Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Richmond, VA, USA.,Internal Medicine Unit, Department of Medicine and Surgery, University of Insubria-Ospedale Di Circolo di Varese, ASST Dei Sette Laghi, Varese, Italy
| | - Adolfo G Mauro
- Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Richmond, VA, USA
| | - Antonio L Brucato
- Department of Biomedical and Clinical Sciences, Fatebenefratelli Hospital, Università di Milano, Milan, Italy
| | - Massimo Imazio
- University Cardiology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Antonio Abbate
- Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Richmond, VA, USA
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27
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Blagova OV, Nedostup AV, Sedov VP, Kogan EA, Alijeva IN, Sorokin GY, Sarkisova ND. [Pericarditis in contemporary therapeutic clinic: nosological spectrum, approaches to diagnosis and treatment]. TERAPEVT ARKH 2020; 92:10-18. [PMID: 33720567 DOI: 10.26442/00403660.2020.12.200432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/07/2021] [Indexed: 11/22/2022]
Abstract
AIM To analyze the register of pericarditis in a therapeutic clinic, to evaluate their nosological spectrum, to optimize approaches to diagnosis and treatment. MATERIALS AND METHODS For the period 20072018, the register includes 76 patients with the diagnosis of pericarditis (average age 53.115.7 years, 2085 years, 46 female). Patients with hydropericardium were not included in the register. Diagnostic puncture of pericardium was carried out in 5 patients, pleural puncture in 11 patients. Morphological diagnostics included endomyocardial/ intraoperative biopsy of myocardium (n=4/2), thoracoscopic/intraoperative biopsy of pericardium (n=1/6), pleural puncture (n=5), transbronchial (n=1), thoracoscopic biopsy of intrathoracic lymph nodes (n=2), lung (n=1), supraclavicular lymph node biopsy (n=1), salivary gland (n=1), subcutaneous fat and rectum biopsy per amyloid (n=6/1). The genome of cardiotropic viruses, level of anti-heart antibodies, C-reactive protein, antinuclear factor, rheumatoid factor (antibodies to cyclic citrullinized peptide), antibodies to neutrophil cytoplasm were determined, extractable nuclear antigens (ENA), protein immunoelectrophoresis, diaskin test, computed tomography of lungs and heart, cardiac magnetic resonance imaging, oncologic search. RESULTS The following forms of pericarditis were verified: tuberculosis (14%, including in combination with hypertrophic cardiomyopathy HCM), acute / chronic viral (8%) and infectious immune (38%), including perimyocarditis in 77%, pericarditis associated with mediastinum lymphoma/sarcoma (4%), sarcoidosis (3%), diffuse diseases of connective tissue and vasculitis (systemic lupus erythematosus, rheumatoid arthritis, diseases of Horton, Takayasu, Shegren, Wegener, 12%), leukoclastic vasculitis, Loefflers endomyocarditis, AL-amyloidosis, thrombotic microangiopathy (1% each), HCM (8%), coronary heart disease (constriction after repeated punctures and suppuration; postinfection and immune, 4%), after radiofrequency catheter ablation and valve prosthetics (2%). Tuberculosis was the main causes of constrictive pericarditis (36%). Treatment included steroids (n=39), also in combination with cytostatics (n=12), anti-tuberculosis drugs (n=9), acyclovir/ganclovir (n=14), hydroxychloroquine (n=23), colchicine (n=13), non-steroidal anti-inflammatory drugs (n=21), L-tyroxine (n=5), chemotherapy (n=1). In 36 patients different types of therapy were combined. Treatment results observed in 55 patients. Excellent and stable results were achieved in 82% of them. Pericardiectomy/pericardial resection was successfully performed in 8 patients. Lethality was 13.2% (10 patients) with an average follow-up 9 [2; 29.5] months (up to 10 years). Causes of death were chronic heart failure, surgery for HCM, pulmonary embolism, tumor. CONCLUSION During a special examination, the nature of pericarditis was established in 97% of patients. Morphological and cytological diagnostics methods play the leading role. Tuberculosis pericarditis, infectious-immune and pericarditis in systemic diseases prevailed. Infectious immune pericarditis is characterized by small and medium exudate without restriction and accompanying myocarditis. Steroids remain the first line of therapy in most cases. Hydroxychloroquine as well as colchicine can be successfully used in moderate / low activity of immune pericarditis and as a long-term maintenance therapy after steroid stop.
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Affiliation(s)
- O V Blagova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - A V Nedostup
- Sechenov First Moscow State Medical University (Sechenov University)
| | - V P Sedov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - E A Kogan
- Sechenov First Moscow State Medical University (Sechenov University)
| | - I N Alijeva
- Sechenov First Moscow State Medical University (Sechenov University)
| | - G Y Sorokin
- Sechenov First Moscow State Medical University (Sechenov University)
| | - N D Sarkisova
- Sechenov First Moscow State Medical University (Sechenov University)
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28
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Lee YJ, Mubasher M, Zainal A, Syed T, Mohamed MFH, Ferrantino M, Hoefen R. Pacemaker-Associated Post-cardiac Injury Syndrome Presenting with Tamponade and Recurrent Pleural Effusion. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2020; 13:1179547620965559. [PMID: 33192113 PMCID: PMC7607781 DOI: 10.1177/1179547620965559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/20/2020] [Indexed: 11/24/2022]
Abstract
Post-cardiac injury syndrome (PCIS) is presumed to be an immune-mediated process. It affects the pericardium and, to a lesser extent, the epicardium, myocardium, and pleura. It has been rarely reported following pacemaker insertion with an estimated incidence of 1% to 2%. We present the case of a 62-year-old female who developed PCIS 8 weeks following pacemaker insertion. She presented with impending cardiac tamponade requiring pericardiocentesis; recurrent pleural effusions subsequently complicated her condition. The pleural effusion recurred despite trials of steroids, eventually requiring talc pleurodesis. This case highlights the need to consider PCIS as a possible etiology of recurrent pleural effusion following pacemaker insertion.
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Affiliation(s)
- Young Ju Lee
- Unity Hospital, Rochester Regional Health, Rochester, New York, USA
| | - Mahmood Mubasher
- Unity Hospital, Rochester Regional Health, Rochester, New York, USA
| | - Abir Zainal
- Unity Hospital, Rochester Regional Health, Rochester, New York, USA
| | - Tausif Syed
- Unity Hospital, Rochester Regional Health, Rochester, New York, USA
| | | | | | - Ryan Hoefen
- Unity Hospital, Rochester Regional Health, Rochester, New York, USA
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29
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Lak H, Shah R, Verma BR, Xu B. A rare complication of a rare disease: Pericarditis due to ruptured pericardial cyst. Echocardiography 2020; 37:1300-1303. [DOI: 10.1111/echo.14714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hassan Lak
- Department of Medicine Cleveland Clinic Cleveland OH USA
| | - Rohan Shah
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH USA
| | - Beni R. Verma
- Department of Medicine Cleveland Clinic Cleveland OH USA
| | - Bo Xu
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH USA
- Section of Cardiovascular Imaging Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH USA
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30
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Alachkar MN, Lehrke M, Marx N, Almalla M. Post-cardiac injury syndrome after transcatheter mitral valve repair using MitraClip system: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 32974454 PMCID: PMC7501910 DOI: 10.1093/ehjcr/ytaa143] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/16/2020] [Accepted: 05/05/2020] [Indexed: 11/14/2022]
Abstract
Background Post-cardiac injury syndrome (PCIS) is an inflammatory process that may occur after myocardial infarction, cardiac surgery, percutaneous cardiac interventions or chest trauma. To our knowledge, PCIS following transcatheter mitral valve repair (TMVr) using the MitraClip system has not been reported. Case summary A 79-year-old female with chronic heart failure and severe mitral regurgitation received TMVr using the MitraClip system. After the procedure she developed elevated inflammatory markers, pericardial and pleural effusion. Cardiac magnetic resonance provided signs of pericardial and pleural inflammation. After initiating an anti-inflammatory therapy with Aspirin and Colchicine, inflammatory markers decreased markedly, pleural and pericardial effusions were regressive, and the patient showed rapid clinical improvement. Discussion Post-cardiac injury syndrome may occur after TMVr and should be considered as a differential diagnosis in patients developing chest pain, signs of pericarditis with or without pericardial effusion and elevated inflammatory markers.
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Affiliation(s)
- Mhd Nawar Alachkar
- Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Michael Lehrke
- Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Nikolaus Marx
- Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Mohammad Almalla
- Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
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31
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Etiologies of pericarditis in hospital and forensic autopsies. Cardiovasc Pathol 2020; 49:107262. [PMID: 32683239 DOI: 10.1016/j.carpath.2020.107262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 01/15/2023] Open
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32
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Gross and histopathological pulmonary findings in a COVID-19 associated death during self-isolation. Int J Legal Med 2020; 134:1285-1290. [PMID: 32504146 PMCID: PMC7273129 DOI: 10.1007/s00414-020-02319-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/19/2020] [Indexed: 12/15/2022]
Abstract
Forensic investigations generally contain extensive morphological examinations to accurately diagnose the cause of death. Thus, the appearance of a new disease often creates emerging challenges in morphological examinations due to the lack of available data from autopsy- or biopsy-based research. Since late December 2019, an outbreak of a novel seventh coronavirus disease has been reported in China caused by “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2). On March 11, 2020, the new clinical condition COVID-19 (Corona-Virus-Disease-19) was declared a pandemic by the World Health Organization (WHO). Patients with COVID-19 mainly have a mild disease course, but severe disease onset might result in death due to proceeded lung injury with massive alveolar damage and progressive respiratory failure. However, the detailed mechanisms that cause organ injury still remain unclear. We investigated the morphological findings of a COVID-19 patient who died during self-isolation. Pathologic examination revealed massive bilateral alveolar damage, indicating early-phase “acute respiratory distress syndrome” (ARDS). This case emphasizes the possibility of a rapid severe disease onset in previously mild clinical condition and highlights the necessity of a complete autopsy to gain a better understanding of the pathophysiological changes in SARS-CoV-2 infections.
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33
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Verma BR, Chetrit M, Gentry Iii JL, Noll A, Bafadel A, Khayata M, Harb SC, Xu B, Kontzias A, Kwon DH, Jellis C, Klein AL. Multimodality imaging in patients with post-cardiac injury syndrome. Heart 2020; 106:639-646. [PMID: 32161040 DOI: 10.1136/heartjnl-2019-316050] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/16/2019] [Accepted: 12/17/2019] [Indexed: 11/04/2022] Open
Abstract
This review article is focused on the role of echocardiography, cardiac CT and cardiac magnetic resonance (CMR) imaging in diagnosing and managing patients with post-cardiac injury syndrome (PCIS). Clinically, the spectrum of pericardial diseases under PCIS varies not only in form and severity of presentation but also in the timing varying from weeks to months, thus making it difficult to diagnose. Pericarditis developing after recent or remote myocardial infarction, cardiac surgery or ablation if left untreated or under-treated could worsen into complicated pericarditis which can lead to decreased quality of life and increased morbidity. Colchicine in combination with other anti-inflammatory agents (non-steroidal anti-inflammatory drugs) is proven to prevent and treat acute pericarditis as well as its relapses under various scenarios. Imaging modalities such as echocardiography, CT and CMR play a pivotal role in diagnosing PCIS especially in difficult cases or when clinical suspicion is low. Echocardiography is the tool of choice for emergent bedside evaluation for cardiac tamponade and to electively study the haemodynamics impact of constrictive pericarditis. CT can provide information on pericardial thickening, calcification, effusions and lead perforations. CMR can provide pericardial tissue characterisation, haemodynamics changes and guide long-term treatment course with anti-inflammatory agents. It is important to be familiar with the indications as well as findings from these multimodality imaging tools for clinical decision-making.
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Affiliation(s)
- Beni R Verma
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Michael Chetrit
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - James L Gentry Iii
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Andrew Noll
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Ahmed Bafadel
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Mohamed Khayata
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Serge C Harb
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Bo Xu
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Apostolos Kontzias
- Rheumatology, Allergy and Immunology, Stony Brook University, Stony Brook, New York, United States
| | - Deborah H Kwon
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Christine Jellis
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States
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34
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Chiabrando JG, Bonaventura A, Vecchié A, Wohlford GF, Mauro AG, Jordan JH, Grizzard JD, Montecucco F, Berrocal DH, Brucato A, Imazio M, Abbate A. Management of Acute and Recurrent Pericarditis. J Am Coll Cardiol 2020; 75:76-92. [DOI: 10.1016/j.jacc.2019.11.021] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 12/21/2022]
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35
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Bhat A, Neculiseanu E, Tam EL, Gendy A, Beckles DL, Luhrs C, Braverman A. Purulent Pericarditis in Sickle Cell Disease Due to Streptococcus agalactiae; a Unique Case Report and Literature Review. Hemoglobin 2019; 43:1-3. [PMID: 30879337 DOI: 10.1080/03630269.2019.1579736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purulent pericarditis is a localized infection with a thick, fibrinous hypercellular exudate and is historically associated with a high mortality. We describe a case of purulent pericarditis due to Streptococcus agalactiae (S. agalactiae) in a 30-year-old woman with sickle cell disease who presented with fever, dyspnea, and S. agalactiae septicemia. Despite timely initiation of antibiotics, she developed a large purulent pericardial effusion requiring surgical pericardiocentesis followed by a pericardial window. At 14 months follow-up, she has remained asymptomatic without sequelae. A review of the literature contained only four patients with purulent pericarditis in sickle cell patients. We discuss the unique aspects of this case in the context of purulent pericarditis in the age of modern antibiotics and hypothesize on the pathogenesis of delayed pericardial effusion after pericarditis.
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Affiliation(s)
- Alina Bhat
- a Downstate College of Medicine, Department of Medicine, Division of Hematology-Oncology , State University of New York , Brooklyn , NY , USA
| | - Elvira Neculiseanu
- a Downstate College of Medicine, Department of Medicine, Division of Hematology-Oncology , State University of New York , Brooklyn , NY , USA
| | - Eric L Tam
- a Downstate College of Medicine, Department of Medicine, Division of Hematology-Oncology , State University of New York , Brooklyn , NY , USA
| | - Adam Gendy
- b Downstate College of Medicine, Department of Surgery, Division of Cardiothoracic Surgery , State University of New York , Brooklyn , NY , USA
| | - Daniel L Beckles
- b Downstate College of Medicine, Department of Surgery, Division of Cardiothoracic Surgery , State University of New York , Brooklyn , NY , USA
| | - Carol Luhrs
- a Downstate College of Medicine, Department of Medicine, Division of Hematology-Oncology , State University of New York , Brooklyn , NY , USA
| | - Albert Braverman
- a Downstate College of Medicine, Department of Medicine, Division of Hematology-Oncology , State University of New York , Brooklyn , NY , USA
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McNamara N, Ibrahim A, Satti Z, Ibrahim M, Kiernan TJ. Acute pericarditis: a review of current diagnostic and management guidelines. Future Cardiol 2019; 15:119-126. [DOI: 10.2217/fca-2017-0102] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This review examined the relevance of chest pain, pericardial friction rub, pericardial effusion and ECG changes in regard to the diagnosis of acute pericarditis. It also assessed the evidence for the management and therapeutic guidelines, specifically nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine and corticosteroids. Overall, there appears to be a lack of research into pericarditis. The bulk of high-quality research seems to have been carried out prior to the publication of the European Society of Cardiology guidelines of 2015. Diagnostically, the current combination of symptoms, clinical signs and investigations offer reasonable criteria for diagnosis, but they are not a gold standard. Research into its therapeutic treatment options is required to address the effects of specific nonsteroidal anti-inflammatory drugs (NSAIDs).
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Affiliation(s)
- Nicholas McNamara
- Cardiology department, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Abdalla Ibrahim
- Cardiology Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Zahir Satti
- Cardiology Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Munir Ibrahim
- Cardiology Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Thomas J Kiernan
- Cardiology Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
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Spoto S, Valeriani E, Locorriere L, Anguissola GB, Pantano AL, Terracciani F, Riva E, Ciccozzi M, Costantino S, Angeletti S. Influenza B virus infection complicated by life-threatening pericarditis: a unique case-report and literature review. BMC Infect Dis 2019; 19:40. [PMID: 30630424 PMCID: PMC6327550 DOI: 10.1186/s12879-018-3606-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 12/10/2018] [Indexed: 12/18/2022] Open
Abstract
Background Acute pericarditis may occur frequently after viral infections. To our knowledge, influenza B virus infection complicated by pericarditis without myocardial involvement has never been reported. We report the first case of life-threatening pericarditis caused by influenza B virus infection. Case presentation A 48-years-old woman with trisomy 21 and ostium primum atrial septal defect was transferred from Cardiology to our Internal Medicine Department for severe pericardial effusion unresponsive to ibuprofen and colchicine. Based on the recent patient history of flu-like syndrome, and presence of pleuro-pericardial effusion, a viral etiology was suspected. Laboratory evaluation and molecular assay of tracheal aspirate identified influenza B virus. Therefore, the ongoing metilprednisolone and colchicine therapy was implemented with oseltamivir with progressive patient improvement and no evidence of pericardial effusion recurrence during follow-up. Conclusions Especially in autumn and winter periods, clinicians should include Influenza B virus infection on differential diagnosis of pericarditis with large pericardial effusion.
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Affiliation(s)
- Silvia Spoto
- Internal Medicine Department, University Campus Bio-Medico of Rome, Italy, Via Alvaro del Portillo, 200, Rome, Italy.
| | - Emanuele Valeriani
- Internal Medicine Department, University G. D'Annunzio, Via dei Vestini, 31, Chieti, Italy
| | - Luciana Locorriere
- Internal Medicine Department, University Campus Bio-Medico of Rome, Italy, Via Alvaro del Portillo, 200, Rome, Italy
| | - Giuseppina Beretta Anguissola
- Internal Medicine Department, University Campus Bio-Medico of Rome, Italy, Via Alvaro del Portillo, 200, Rome, Italy
| | - Angelo Lauria Pantano
- Internal Medicine Department, University Campus Bio-Medico of Rome, Italy, Via Alvaro del Portillo, 200, Rome, Italy
| | - Francesca Terracciani
- Internal Medicine Department, University Campus Bio-Medico of Rome, Italy, Via Alvaro del Portillo, 200, Rome, Italy
| | - Elisabetta Riva
- Unit of Virology, University Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistic and Molecular Epidemiology, University Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200, Rome, Italy
| | - Sebastiano Costantino
- Internal Medicine Department, University Campus Bio-Medico of Rome, Italy, Via Alvaro del Portillo, 200, Rome, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200, Rome, Italy
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Rabinowitz EJ, Meyer DB, Kholwadwala P, Kohn N, Bakar A. Does Prophylactic Ibuprofen After Surgical Atrial Septal Defect Repair Decrease the Rate of Post-Pericardiotomy Syndrome? Pediatr Cardiol 2018; 39:1535-1539. [PMID: 29948034 DOI: 10.1007/s00246-018-1926-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/06/2018] [Indexed: 12/24/2022]
Abstract
Post-pericardiotomy syndrome (PPS) is an inflammatory process involving the pleura, pericardium, or both and occurs after cardiothoracic surgery. Surgical atrial septal defect (ASD) closure is associated with higher incidence of PPS post-operatively as compared to other operations. Reported incidence of PPS varies from 1 to 40%. NSAIDs are often used to treat PPS and in our center, some practitioners have prescribed ibuprofen prophylactically. This study sought to investigate the impact of prophylactic treatment with ibuprofen on the development and severity of PPS following surgical ASD closure, with particular attention to secundum-type ASDs. We retrospectively reviewed clinical and operative data of all surgical ASD repairs in our center from 1/2007 to 7/2017. ASDs were grouped by subtype. PPS was considered positive if the primary cardiologist diagnosed and documented clinical signs of PPS on post-operative outpatient follow-up. Records were reviewed to confirm documented diagnosis of PPS. A total of 245 cases were reviewed with 207 having sufficient data. Median age was 2 years (range 4 months-27 years), female 57%. Overall incidence of PPS was 10%. There was no difference in incidence of PPS in those prescribed ibuprofen as compared to those who were not. This was true for both the entire cohort and the subgroup analysis (P = 1.0). Four patients overall required pericardiocentesis, none of whom received prophylactic ibuprofen. Prophylactic ibuprofen prescription following surgical ASD repair did not reduce the rate of PPS in our cohort.
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Affiliation(s)
- Edon J Rabinowitz
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York, Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA.
| | - David B Meyer
- Division of Cardiothoracic Surgery, Cohen Children's Medical Center of New York, Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Priya Kholwadwala
- Department of Pediatrics, Cohen Children's Medical Center of New York, Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
| | - Nina Kohn
- Department of Biostatistics, Feinstein Institute for Medical Research, Hofstra Northwell School of Medicine, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Adnan Bakar
- Division of Pediatric Cardiology, Cohen Children's Medical Center of New York, Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA.,Division of Pediatric Critical Care Medicine, Cohen Children's Medical Center of New York, Hofstra Northwell School of Medicine, 269-01 76th Ave, New Hyde Park, NY, 11040, USA
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Brucato A, Imazio M, Cremer PC, Adler Y, Maisch B, Lazaros G, Gattorno M, Caforio ALP, Marcolongo R, Emmi G, Martini A, Klein AL. Recurrent pericarditis: still idiopathic? The pros and cons of a well-honoured term. Intern Emerg Med 2018; 13:839-844. [PMID: 30022399 DOI: 10.1007/s11739-018-1907-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/10/2018] [Indexed: 01/01/2023]
Abstract
In developed countries, more than 80% of cases of acute pericarditis remain without an established diagnosis after a conventional and standard diagnostic approach. These cases are generally labelled as 'idiopathic', i.e. without a known cause. This lack of information is a matter of concern for both patients and clinicians. Some years ago, this term reflected the state of the art of scientific knowledge on the topic. Advances have changed this point of view, in light of available molecular techniques like polymerase chain reaction able to identify viral cardiotropic agents in pericardial fluid and biopsies. Furthermore, the remarkable efficacy of interleukin-1 antagonists, a therapy targeting the innate immune response, suggests clinical and pathogenic similarity between a proportion of patients with idiopathic recurrent pericarditis and classical autoinflammatory diseases. So, it seems useful to discuss the pros and cons of using the term "idiopathic" in light of the new knowledge.
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Affiliation(s)
- Antonio Brucato
- Internal Medicine, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Massimo Imazio
- Cardiovascular and Thoracic Department, AOU Città DELLA Salute e della Scienza, University Cardiology, Turin, Italy
| | - Paul C Cremer
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Yehuda Adler
- The Sackler Faculty of Medicine Tel Aviv University, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Bernhard Maisch
- Faculty of Medicine, Philipps University of Marburg, Marburg, Germany
| | - George Lazaros
- Department of Cardiology, Hippokration Hospital, University of Athens Medical School, Athens, Greece
| | - Marco Gattorno
- Clinic of Pediatrics and Rheumatology, Unit of Autoinflammatory Diseases and Immunodeficiencies, "G. Gaslini" Institute, Genoa, Italy
| | - Alida L P Caforio
- Division of Cardiology, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Renzo Marcolongo
- Clinical Immunology, Department of Medicine, Azienda Ospedaliera-Università, Padua, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Largo Brambilla 3, 50134, Florence, Italy.
| | - Alberto Martini
- Clinic of Pediatrics and Rheumatology, Unit of Autoinflammatory Diseases and Immunodeficiencies, "G. Gaslini" Institute, Genoa, Italy
- "G. Gaslini" Institute, Scientific Direction, University of Genoa, Genoa, Italy
| | - Allan L Klein
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Olagne L, Smets P, Eschalier R, Cassagnes L, Aumaître O, André M. Pericarditis in a Department of Internal Medicine. J Cardiovasc Med (Hagerstown) 2018; 19:391-392. [DOI: 10.2459/jcm.0000000000000639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Acute and recurrent pericarditis is the most common pericardial syndrome encountered in clinical practice either as an isolated process or as part of a systemic disease. The diagnosis is based on clinical evaluation, electrocardiogram, and echocardiography. The empiric therapy is based on nonsteroidal anti-inflammatory drugs plus colchicine as first choice, resorting to corticosteroids for specific indications (eg, systemic inflammatory disease on corticosteroids, pregnancy, renal failure, concomitant oral anticoagulants), for contraindications or failure of the first-line therapy. The most common complication is recurrence, occurring in up to 30% of cases after a first episode of pericarditis.
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Gérard D, Thomas B, Lesesve JF. Non-small cell lung carcinoma metastatic cells in a pericardial effusion. Cytopathology 2018; 29:311-312. [PMID: 29714042 DOI: 10.1111/cyt.12545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2018] [Indexed: 11/27/2022]
Affiliation(s)
- D Gérard
- Service d'Hématologie Biologique, University Hospital, Nancy, France
| | - B Thomas
- Service d'Hématologie Biologique, University Hospital, Nancy, France
| | - J-F Lesesve
- Service d'Hématologie Biologique, University Hospital, Nancy, France
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43
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Cho E, Park SW, Jun CH, Shin SS, Park EK, Lee KS, Park SY, Park CH, Kim HS, Choi SK, Rew JS. A rare case of pericarditis and pleural empyema secondary to transdiaphragmatic extension of pyogenic liver abscess. BMC Infect Dis 2018; 18:40. [PMID: 29334903 PMCID: PMC5769516 DOI: 10.1186/s12879-018-2953-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 01/08/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Transdiaphragmatic extension of pyogenic liver abscess is the rarest cause of pericarditis and pleural empyema. It is a rapidly progressive and highly lethal infection with mortality rates reaching 100% if left untreated. However, the transmission route, treatment methods and prognosis have not been well studied. CASE PRESENTATION A 65-year-old male patient presented with a fever, dyspnea, and right upper quadrant abdominal pain. Computed tomography of the chest and abdomen showed huge liver abscess without full liquefaction in the left lobe, large amount of left pleural effusion, and mild pericardial effusion, and the patient was treated with parenteral antibiotics and pigtail insertion at the left pleura. However, four days later, cardiac tamponade was developed and surgical drainage of the abscess and pericardium was performed. Klebsiella pneumonia was isolated from pleural empyema. Twenty-five days after surgery, the patient was discharged without any complications. CONCLUSIONS Herein, we report a rare case of pleural empyema and pericarditis in that resulted from the extension of huge pyogenic liver abscess. Early surgical treatment may have prevented progression of the pericarditis to the more dismal purulent pericarditis. We also review pertinent English literature on pericarditis as a complication of PLA.
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Affiliation(s)
- Eunae Cho
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Sang Woo Park
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Chung Hwan Jun
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea.
| | - Sang Soo Shin
- Department of Radiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Eun Kyu Park
- Department of Surgery, Chonnam National University Medical School, Gwangju, South Korea
| | - Kyo Seon Lee
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Gwangju, South Korea
| | - Seon Young Park
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Chang Hwan Park
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Hyun Soo Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Sung Kyu Choi
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Jong Sun Rew
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea
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Assayag M, Abbas R, Chanson N, Perozziello A, Ducrocq G, Alexandra JF, Dossier A, Papo T, Sacre K. Diagnosis of systemic inflammatory diseases among patients admitted for acute pericarditis with pericardial effusion. J Cardiovasc Med (Hagerstown) 2017; 18:875-880. [PMID: 28937580 DOI: 10.2459/jcm.0000000000000576] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Acute pericarditis may be the heralding manifestation of various systemic inflammatory diseases (SIDs). The aim of this study was to identify clinical indicators for SIDs in patients admitted for acute pericarditis with pericardial effusion. METHODS All consecutive adult patients hospitalized in a Department of Internal Medicine over a 10-year period for acute pericarditis with pericardial effusion were retrospectively reviewed. Patients with cancer and tuberculosis were excluded. A structured clinical panel for extra-cardiac symptoms of SIDs was applied. SIDs were classified using current international criteria. RESULTS Ninety-nine patients were admitted for acute pericarditis with pericardial effusion. After exclusion, 74 (49.7 ± 19.7 years, 56.7% women) patients were analyzed. Among them, 23 (23.2%) patients had a SID that was revealed by pericarditis in 12 cases. Systemic lupus erythematosus, undifferentiated connective-tissue disease, and Sjogren's syndrome accounted for 75% of the SID. Patients with SIDs were younger (P < 0.001), more frequently of female sex (P = 0.025), and had a higher frequency of extra-cardiac symptoms (P < 0.001) including arthralgia, myalgia, Raynaud phenomenon, and skin rash, as compared with patients with idiopathic pericarditis (n = 51). Overall, after exclusion of neoplasm and tuberculosis, the probability of SIDs in patients admitted with an acute pericarditis with pericardial effusion was 89.7% in patients younger than 50 who had extra-cardiac symptoms. Conversely, the probability fell to 8.4% in patients older than 50 with no extra-cardiac symptoms. CONCLUSION Both age and extra-cardiac symptoms suggest an underlying SID as a possible cause of acute pericarditis.
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Affiliation(s)
- Maureen Assayag
- aDépartement de Médecine Interne bDépartement d'Epidémiologie et Recherche Clinique cDépartement d'Information Médicale dDépartement de Cardiologie, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris eINSERM U1149 fDépartement Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases), Paris, France
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45
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Pleural effusions in acute idiopathic pericarditis and postcardiac injury syndrome. Curr Opin Pulm Med 2017; 23:346-350. [DOI: 10.1097/mcp.0000000000000383] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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46
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Complicated Pericarditis: Understanding Risk Factors and Pathophysiology to Inform Imaging and Treatment. J Am Coll Cardiol 2017; 68:2311-2328. [PMID: 27884251 DOI: 10.1016/j.jacc.2016.07.785] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/05/2016] [Accepted: 07/12/2016] [Indexed: 01/09/2023]
Abstract
Most patients with acute pericarditis have a benign course and a good prognosis. However, a minority of patients develop complicated pericarditis, and the care of these patients is the focus of this review. Specifically, we address risk factors, multimodality imaging, pathophysiology, and novel treatments. The authors conclude that: 1) early high-dose corticosteroids, a lack of colchicine, and an elevated high-sensitivity C-reactive protein are associated with the development of complicated pericarditis; 2) in select cases, cardiovascular magnetic resonance imaging may aid in the assessment of pericardial inflammation and constriction; 3) given phenotypic similarities between recurrent idiopathic pericarditis and periodic fever syndromes, disorders of the inflammasome may contribute to relapsing attacks; and 4) therapies that target the inflammasome may lead to more durable remission and resolution. Finally, regarding future investigations, the authors discuss the potential of cardiovascular magnetic resonance to inform treatment duration and the need to compare steroid-sparing treatments to pericardiectomy.
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Abstract
Pericardial diseases are not uncommon in daily clinical practice. The spectrum of these syndromes includes acute and chronic pericarditis, pericardial effusion, constrictive pericarditis, congenital defects, and neoplasms. The extent of the high-quality evidence on pericardial diseases has expanded significantly since the first international guidelines on pericardial disease management were published by the European Society of Cardiology in 2004. The clinical practice guidelines provide a useful reference for physicians in selecting the best management strategy for an individual patient by summarizing the current state of knowledge in a particular field. The new clinical guidelines on the diagnosis and management of pericardial diseases that have been published by the European Society of Cardiology in 2015 represent such a tool and focus on assisting the physicians in their daily clinical practice. The aim of this review is to outline and emphasize the most clinically relevant new aspects of the current guidelines as compared with its previous version published in 2004.
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48
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Elbaz-Greener G, Wijeysundera HC. A presentation of postcardiac injury syndrome after successful chronic total occlusion percutaneous coronary intervention using dissection re-entry techniques. Clin Case Rep 2017; 5:855-858. [PMID: 28588825 PMCID: PMC5458034 DOI: 10.1002/ccr3.955] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/12/2017] [Accepted: 03/18/2017] [Indexed: 11/08/2022] Open
Abstract
Retrograde dissection re‐entry can cause pericardial trauma of sufficient degree to lead to the development of an auto‐immune postpericardial injury syndrome. Clinical suspicion for this condition should be high in the event of fever, symptoms, pericardial/pleural effusion, and pleuritic chest pain following chronic total occlusion (CTO) Post cardiac injury syndromes (PCI).
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Affiliation(s)
- Gabby Elbaz-Greener
- Schulich Heart Center Sunnybrook Health Sciences Center University of Toronto Toronto Ontario Canada
| | - Harindra C Wijeysundera
- Schulich Heart Center Sunnybrook Health Sciences Center University of Toronto Toronto Ontario Canada
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Greub G, Sahli R, Brouillet R, Jaton K. Ten years of R&D and full automation in molecular diagnosis. Future Microbiol 2016; 11:403-25. [PMID: 27028061 DOI: 10.2217/fmb.15.152] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A 10-year experience of our automated molecular diagnostic platform that carries out 91 different real-time PCR is described. Progresses and future perspectives in molecular diagnostic microbiology are reviewed: why automation is important; how our platform was implemented; how homemade PCRs were developed; the advantages/disadvantages of homemade PCRs, including the critical aspects of troubleshooting and the need to further reduce the turnaround time for specific samples, at least for defined clinical settings such as emergencies. The future of molecular diagnosis depends on automation, and in a novel perspective, it is time now to fully acknowledge the true contribution of molecular diagnostic and to reconsider the indication for PCR, by also using these tests as first-line assays.
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Affiliation(s)
- Gilbert Greub
- Institute of Microbiology, University of Lausanne & University Hospital Center, Lausanne, Switzerland
| | - Roland Sahli
- Institute of Microbiology, University of Lausanne & University Hospital Center, Lausanne, Switzerland
| | - René Brouillet
- Institute of Microbiology, University of Lausanne & University Hospital Center, Lausanne, Switzerland
| | - Katia Jaton
- Institute of Microbiology, University of Lausanne & University Hospital Center, Lausanne, Switzerland
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50
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Characteristics of Pleural Effusions in Acute Idiopathic Pericarditis and Post-Cardiac Injury Syndrome. Ann Am Thorac Soc 2016; 13:298-300. [PMID: 26848607 DOI: 10.1513/annalsats.201510-668le] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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