Complicated Pericarditis: Understanding Risk Factors and Pathophysiology to Inform Imaging and Treatment

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• 作者：Paul C. Cremer ; MD^a ; Arnav Kumar ; MD^a ; Apostolos Kontzias ; MD^b ; Carmela D. Tan ; MD^c ; E. Rene Rodriguez ; MD^c ; Massimo Imazio ; MD^d ; Allan L. Klein ; MD^a ; ^{kleina@ccf.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：autoimmune diseases ; cardiovascular magnetic resonance imaging ; colchicine ; inflammasome ; inflammation ; pericardiectomy
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：29 November 2016
• 年：2016
• 卷：68
• 期：21
• 页码：2311-2328
• 全文大小：6380 K

文摘

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.