Cardiac Magnetic Resonance Imaging Pericardial Late Gadolinium Enhancement and Elevated Inflammatory Markers Can Predict the Reversibility of Constrictive Pericarditis After Antiinflammatory Medical Therapy

OBJECTIVES: Constrictive pericarditis (CP) is a disabling disease, and usually requires pericardiectomy to relieve heart failure. Reversible CP has been described, but there is no known method to predict the reversibility. Pericardial inflammation may be a marker for reversibility. As a pilot study, we assessed whether cardiac magnetic resonance imaging pericardial late gadolinium enhancement (LGE) and inflammatory biomarkers could predict the reversibility of CP after anti-inflammatory therapy.

METHODS: Twenty-nine CP patients received anti-inflammatory medications after cardiac magnetic resonance imaging. Fourteen patients had resolution of CP, whereas 15 patients had persistent CP after 13 months of follow-up. Baseline LGE pericardial thickness was greater in the group with reversible CP than in the persistent CP group (4±1 versus 2±1 mm, P=0.001). Qualitative intensity of pericardial LGE was moderate or severe in 93% of the group with reversible CP and in 33% of the persistent CP group (P=0.002).

RESULTS: Cardiac magnetic resonance imaging LGE pericardial thickness ≥3 mm had 86% sensitivity and 80% specificity to predict CP reversibility. The group with reversible CP also had higher baseline C-reactive protein and erythrocyte sedimentation rate than the persistent CP group (59±52 versus 12±14 mg/L, P=0.04 and 49±25 versus 15±16 mm/h, P=0.04, respectively). Anti-inflammatory therapy was associated with a reduction in C-reactive protein, erythrocyte sedimentation rate, and pericardial LGE in the group with reversible CP but not in the persistent CP group.

CONCLUSIONS: Reversible CP was associated with pericardial and systemic inflammation. Anti-inflammatory therapy was associated with a reduction in pericardial and systemic inflammation and LGE pericardial thickness, with resolution of CP physiology and symptoms. Further studies in a larger number of patients are needed.

PMID: 21969014

Posted in Magnetic Resonance Imaging and tagged , , , , , , .

2 Comments

  1. Does MRI have incremental value to CRP?:

    Prevalence of C-reactive protein elevation and time course of normalization in acute pericarditis: implications for the diagnosis, therapy, and prognosis of pericarditis.
    Imazio M, Brucato A, Maestroni S, Cumetti D, Dominelli A, Natale G, Trinchero R.
    Circulation. 2011 Mar 15;123(10):1092-7.
    PMID: 21357824

  2. On LGE of the pericardium, the authors make a very interesting comment: “Interestingly, the percentage of patients positive for pericardial LGE… was not significantly different between the 2 groups. Normal pericardium is poorly vascularized and has no significant LGE even though it is rich in collagen. For patients who had a thickened pericardium but no inflammation, the vascular density is low, and gadolinium distribution may be limited even though the extracellular space is increased with significant fibrosis. These patients have either no or minimal LGE, which is different from myocardium scar or fibrosis. In contrast, patients with a thickened and inflamed pericardium have hyperemia and increased vascular density, likely resulting in a significant LGE. Thus, our observations suggest that the severity of LGE is more informative than the mere presence of LGE in differentiating pericardial inflammation and the reversibility of CP.”

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