Cardiac MR provides superior diagnostic information in pericarditis cases

Portugal: Cardiac magnetic resonance (CMR) is a useful tool to tailor individual therapy, specifically in recurrent and constrictive pericarditis cases, research finds. Late and gadolinium enhancement provides prognostic and diagnostic information, and multiparametric mapping emerges as a promising tool with incremental diagnostic value. The study appears in European Heart Journal - Case Reports. 

Cardiac magnetic resonance plays a unique role in evaluating pericardial disease, allowing non-invasive tissue analysis, and hemodynamic assessment. T Branco Mano, Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal, and colleagues described three clinical cases that illustrate the indispensable role of CMR in the evaluation of the broad spectrum of pericardial diseases.

Case 1 is of a 23-year-old female having no past medical history except Polycystic Ovary Syndrome, previously hospitalized with polyserositis (pericardial and pleural effusions) and treated with colchicine and prednisolone had recurrent chest pain after tapering and discontinuing corticosteroid therapy. A CMR study confirmed recurrent pericarditis and concomitant myocardial involvement (myopericarditis) with preserved left ventricular ejection fraction (69%). CMR showed increased pericardial thickness with marked pericardial late gadolinium enhancement (LGE). native T1 mapping distinguishes pericardial inflammation (high signal—bright image) from fat (low signal—dark image). 

Case 2 is of a 75-year-old-man with a diagnosis of heart failure with preserved ejection fraction, medical history of multiple cardiovascular risk factors (type 2 diabetes mellitus, arterial hypertension, smoking, and dyslipidemia), chronic obstructive pulmonary disease, and prostate cancer (treated with local surgery and hormone therapy). Cardiac magnetic resonance confirmed a marked increase in pericardial thickness (8 mm), signs of constrictive physiology with ongoing inflammation. 

Case 3 is of a 59-year-old-female with a prior history of acute decompensated heart failure in the context of atrial tachycardia, 2 years ago, was admitted due to progressive exertional dyspnoea. A CMR study confirmed a chronic form of CP without myocardial involvement: thickened pericardium, biatrial enlargement, constrictive physiology and pericardial adherence. 

"CMR's unique ability to combine the evaluation of anatomy, hemodynamic and inflammatory status, gives superior diagnostic information," wrote the authors. "These inflammatory syndromes are not mutually exclusive, but rather a continuum in the phenotypes in a wide spectrum of pericardial diseases, sometimes overlapping or transitioning from one phase to the other."

"Cardiac magnetic resonance is an effective tool to tailor individual therapy, particularly in cases of recurrent and constrictive pericarditis, given that the presence of ongoing inflammation has been found to be the best predictor of reversibility," they concluded.

Reference:

T Branco Mano, H Santos, S Aguiar Rosa, B Thomas, L Baquero, Cardiac magnetic resonance in the assessment of pericardial abnormalities: a case series, European Heart Journal - Case Reports, Volume 5, Issue 12, December 2021, ytab444, https://doi.org/10.1093/ehjcr/ytab444