Pericardial Diseases: International Position Statement on New Concepts and Advances in Multi-Modality Cardiac Imaging - JIMG August 2024-Article: Pericardial Diseases: International Position Statement on New Concepts and Advances in Multi-Modality Cardiac Imaging

Article: Pericardial Diseases: International Position Statement on New Concepts and Advances in Multi-Modality Cardiac Imaging

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Pericardial diseases, including pericarditis and pericardial effusion (PEff), have seen major advancements, particularly in multimodal cardiac imaging and targeted treatments such as anti–interleukin (IL)-1 agents like anakinra, rilonacept, and goflikicept. Multimodal imaging (MMI), including echocardiography, cardiac computed tomography (CT), and cardiac magnetic resonance (CMR), is essential for accurate diagnosis and monitoring. Traditional guidelines do not reflect the latest practices and clinical trials, leading to an educational gap among clinicians.<br /><br />Acute and recurrent pericarditis are characterized by chest pain, pericardial rub, ECG changes, and PEff, with the diagnosis bolstered by imaging and biomarkers like C-reactive protein (CRP). Treatment typically involves NSAIDs, colchicine, and in refractory cases, corticosteroids or anti–IL-1 agents. CMR imaging helps assess pericardial inflammation and guides therapy, reducing recurrence and steroid reliance.<br /><br />Pericardial effusion (PEff) can result from various causes such as viral infections, malignancies, or post-cardiac procedures. It is categorized by size, onset, and hemodynamic impact, with echocardiography being the first-line diagnostic tool. Large or symptomatic effusions may require pericardiocentesis or surgical intervention. Chronic effusions without inflammation are generally managed conservatively.<br /><br />Constrictive pericarditis (CP) is marked by a stiffened pericardium impairing diastolic filling, often necessitating pericardiectomy. Effusive-constrictive pericarditis (ECP) involves concurrent CP and significant PEff, requiring careful differentiation and often initial anti-inflammatory therapy. CMR helps identify cases where CP could be reversible with medical therapy.<br /><br />The field emphasizes an integrated MMI approach to evaluate diseases and guide individualized treatment plans, with advanced imaging playing a vital role. Novel anti-inflammatory therapies offer promising treatment options for recurrent or corticosteroid-dependent pericarditis. Continued advancements in imaging techniques and targeted treatments are shaping the modern management landscape of pericardial diseases.

Keywords

pericardial diseases

pericarditis

pericardial effusion

multimodal imaging

anti-IL-1 agents

cardiac imaging

C-reactive protein

constrictive pericarditis

effusive-constrictive pericarditis

pericardiocentesis