Quantitative Assessment of Pericardial Delayed Hyperenhancement Predicts Clinical Improvement in Patients With Constrictive Pericarditis Treated With Anti-Inflammatory Therapy. (May 2015)

• Record Type: Journal Article
• Authors: Cremer, Paul C.; Tariq, Muhammad U.; Karwa, Abhishek; Alraies, M. Chadi; Benatti, Rodolfo; Schuster, Andres; Agarwal, Shikhar; Flamm, Scott D.; Kwon, Deborah H.; Klein, Allan L.
• Is Part Of: Circulation. Volume 8:Number 5(2015)
• Publication Date: 2015-05
• Subjects: Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.1075405
• DOI: 10.1161/CIRCIMAGING.114.003125
• Languages: English
• ISSNs: 1941-9651

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background—</title> <p>Delayed hyperenhancement (DHE) of the pericardium usually represents ongoing inflammation and may identify patients with constrictive pericarditis that will improve with anti-inflammatory therapy. However, a quantitative assessment of pericardial DHE has not been performed, and the hierarchical relationship among clinical factors, inflammatory markers, and pericardial DHE is unknown.</p> </sec> <sec> <title>Methods and Results—</title> <p>We identified 41 consecutive patients with constrictive pericarditis who had a cardiovascular magnetic resonance study with DHE prior to the initiation of anti-inflammatory medications. Pericardial inflammation was quantified on short-axis DHE sequences by contouring the pericardium, selecting normal septal myocardium as a reference region, and then quantifying the pericardial signal that was >6 SD above the reference. Our primary outcome was clinical improvement with anti-inflammatory therapy. The mean age of our patients was 58 years, most patients were male (83%) with New York Heart Association Class II or III (59%) heart failure, and the median follow-up was 1 year. Chest pain, lower New York Heart Association class, higher Westergren sedimentation rates, and increased pericardial DHE were all significantly associated with clinical improvement (<italic>P</italic><0.01 for all). When quantitative pericardial DHE was added to a model that included age, chest pain, New York Heart Association class, and Westergren sedimentation rates, the global χ<sup>2</sup> improved significantly (<italic>P</italic>=0.04 for DHE), and the area under the receiver operating characteristic curve was 0.96.</p> </sec> <sec> <title>Conclusions—</title> <p>In patients with constrictive pericarditis treated with anti-inflammatory therapy, a quantitative assessment of pericardial DHE can provide incremental information to predict clinical improvement when added to clinical factors and Westergren sedimentation rates.</p> </sec> </abstract>