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Cardiology

Advances in Imaging and Targeted Therapies for Recurrent PericarditisA Review

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JAMA Cardiology
Published Online: August 17, 2022
Review
Sachin Kumar, MD1;
Shameer Khubber, MD1;
Reza Reyaldeen, MD1;
Ankit Agrawal, MD1;
Paul C. Cremer, MD1;
Massimo Imazio, MD2;
Deborah H. Kwon, MD1;
Allan L. Klein, MD1
Author Affiliations
  • 1Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
  • 2Cardiology, Cardiothoracic Department, University Hospital Santa Maria della Misericordia, Udine, Italy
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Transthoracic Echocardiogram Showing Signs of Constrictive Physiology
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Cardiac Magnetic Resonance Finding in Constrictive Pericarditis
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Abstract

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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  1. Transthoracic Echocardiogram Showing Signs of Constrictive Physiology

  2. Cardiac Magnetic Resonance Showing Signs of Constrictive Physiology

  3. Cardiac Magnetic Resonance Finding in Constrictive Pericarditis

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

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Cardiology Pericardial Disease Cardiac Imaging Radiology Pharmacy and Clinical Pharmacology Cardiovascular Images
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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