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Incremental value of cardiac magnetic resonance for the diagnosis of pericarditis

Session Poster session 2

Speaker Sara Palacio Restrepo

Event : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Pericardium
  • Session type : Poster Session

Authors : S Palacio Restrepo (Turin,IT), M Imazio (Turin,IT), P Sormani (Milan,IT), P Pedrotti (Milan,IT), G Quarta (Bergamo,IT), A Brucato (Bergamo,IT), C Giannattasio (Milan,IT), C Giustetto (Turin,IT), G De Ferrari (Turin,IT), C Bucciarelli Ducci (Bristol,GB)

Authors:
S Palacio Restrepo1 , M Imazio1 , P Sormani2 , P Pedrotti2 , G Quarta3 , A Brucato3 , C Giannattasio2 , C Giustetto1 , G De Ferrari1 , C Bucciarelli Ducci4 , 1Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an - Turin - Italy , 2Niguarda Ca' Granda Hospital, Cardiology - Milan - Italy , 3Ospedale Papa Giovanni XXIII, Cardiology - Bergamo - Italy , 4Bristol Heart Institute, Cardiovascular Imaging - Bristol - United Kingdom of Great Britain & Northern Ireland ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii370

Background: the diagnosis of pericarditis is based on the presence of at least 2 of 4 clinical criteria between pericarditis chest pain, pericardial rubs, ECG changes, and new or worsening pericardial effusion. Elevated C-reactive protein (CRP) and cardiac magnetic resonance (CMR) are helpful in atypical, doubtful cases. CMR offers the capability to detect pericarditis by assessment of pericardial thickening, oedema by STIR-T2w imaging, late gadolinium enhancement (LGE), and presence of pericardial effusion.

Purpose: aim of the present study is to assess the sensitivity and specificity of CMR findings and their possible incremental value over clinical criteria and C-reactive protein elevation as well as their possible prognostic implications.

Methods and results: Cohort study of consecutive patients with pericarditis evaluated by CMR. We included 128 consecutive cases of pericarditis (60 males, 46.9%; mean age 48±14 years). CMR was performed at a mean time of 18 days (95%CI 15-21) after the clinical diagnosis. Sensitivity and specificity for CMR criteria for pericarditis were respectively: 28.9% and 98.4% for pericardial thickening, 68.0% and 100.0% for pericardial edema, 64.8% and 99.2% for pericardial LGE, 52.3% and 89.8% for pericardial effusion, and 72.7% and 99.2% for pericardial edema and LGE. Area under the ROC was greater including clinical criteria plus C-reactive protein elevation and CMR criteria for pericarditis (AUC=0.992) than clinical criteria only (AUC=0.914).

In multivariable analysis, only elevation of CRP (OR 6.8 95%CI 2.4-19.5) and pericardial thickening (OR 9.2 95%CI 2.9-28.8) were independent predictors of adverse events at follow-up.

Conclusions: CMR criteria for the diagnosis of pericarditis should include pericardial edema and LGE. CMR may be helpful to confirm the diagnosis of pericarditis, if performed within 2 weeks after the diagnosis, when clinical criteria are not sufficient. Elevation of CRP at baseline and pericardial thickening (but not oedema/LGE that may be reversible after therapy) are predictors of complications.

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