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Advances in Imaging and Targeted Therapies for Recurrent PericarditisA Review

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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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Article Information

Accepted for Publication: June 24, 2022.

Published Online: August 17, 2022. doi:10.1001/jamacardio.2022.2584

Corresponding Author: Allan L. Klein, MD, Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave, Desk J1-5, Cleveland, OH 44195 (kleina@ccf.org).

Author Contributions: Dr Klein had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Kumar, Khubber, Agrawal, Cremer, Imazio, Klein.

Acquisition, analysis, or interpretation of data: Kumar, Reyaldeen, Imazio, Kwon, Klein.

Drafting of the manuscript: Kumar, Khubber, Reyaldeen, Agrawal, Imazio, Klein.

Critical revision of the manuscript for important intellectual content: Kumar, Reyaldeen, Cremer, Imazio, Kwon, Klein.

Administrative, technical, or material support: Kumar, Reyaldeen, Kwon.

Supervision: Reyaldeen, Cremer, Imazio, Kwon, Klein.

Other: Agrawal.

Conflict of Interest Disclosures: Dr Cremer reports research grants from Novartis and Kiniksa Pharmaceuticals and serves on the scientific advisory board of Kiniksa Pharmaceuticals. Dr Imazio reported previously serving on the scientific advisory board for Kiniksa Pharmaceuticals and Swedish Orphan Biovitrum AB. Dr Klein reported research grants from Kiniksa Pharmaceuticals and serving on the scientific advisory boards of Kiniksa Pharmaceuticals, Swedish Orphan Biovitrum AB, Pfizer, and Cardiol Therapeutics outside the submitted work. No other disclosures were reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

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Buckley  LF , Viscusi  MM , Van Tassell  BW , Abbate  A .  Interleukin-1 blockade for the treatment of pericarditis.   Eur Heart J Cardiovasc Pharmacother. 2018;4(1):46-53. doi:10.1093/ehjcvp/pvx018 PubMedGoogle ScholarCrossref
Klein  AL , Lin  D , Cremer  PC ,  et al.  Efficacy and safety of rilonacept for recurrent pericarditis: results from a phase II clinical trial.   Heart. 2020;107(6):488-496. doi:10.1136/heartjnl-2020-317928 PubMedGoogle ScholarCrossref
Kougkas  N , Fanouriakis  A , Papalopoulos  I ,  et al.  Canakinumab for recurrent rheumatic disease associated-pericarditis: a case series with long-term follow-up.   Rheumatology (Oxford). 2018;57(8):1494-1495. doi:10.1093/rheumatology/key077 PubMedGoogle ScholarCrossref
Epçaçan  S , Sahin  S , Kasapcopur  O .  Anaphylactic reaction to anakinra in a child with steroid-dependent idiopathic recurrent pericarditis and successful management with canakinumab.   Cardiol Young. 2019;29(4):549-551. doi:10.1017/S1047951119000672 PubMedGoogle ScholarCrossref
Signa  S , D’Alessandro  M , Consolini  R ,  et al.  Failure of anti interleukin-1 β monoclonal antibody in the treatment of recurrent pericarditis in two children.   Pediatr Rheumatol Online J. 2020;18(1):51. doi:10.1186/s12969-020-00438-5 PubMedGoogle ScholarCrossref
Imazio  M , Andreis  A , De Ferrari  GM ,  et al.  Anakinra for corticosteroid-dependent and colchicine-resistant pericarditis: The IRAP (International Registry of Anakinra for Pericarditis) study.   Eur J Prev Cardiol. 2020;27(9):956-964. doi:10.1177/2047487319879534 PubMedGoogle ScholarCrossref
Imazio  M , Andreis  A , Piroli  F ,  et al.  Anti-interleukin 1 agents for the treatment of recurrent pericarditis: a systematic review and meta-analysis.   Heart. 2021;heartjnl-2020-318869. doi:10.1136/heartjnl-2020-318869 PubMedGoogle ScholarCrossref
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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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